Conjugated estrogen compositions, applicators, kits, and methods of making and use thereof

ABSTRACT

The present invention is directed to monophasic pharmaceutical compositions comprising a conjugated estrogen and a hydrophilic or lipophilic excipient. The present invention is also directed to kits and applicators comprising the pharmaceutical compositions. The invention is also directed to methods for treating menopausal conditions in a female comprising administration of the pharmaceutical compositions.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of the filing date of U.S.application Ser. No. 60/753,399, filed Dec. 27, 2005, which is herebyincorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention is directed to monophasic pharmaceuticalcompositions comprising a conjugated estrogen and a hydrophilic orlipophilic excipient. The present invention is also directed to kits andapplicators comprising the pharmaceutical compositions. The invention isalso directed to methods for treating menopausal conditions in a femalecomprising administering the pharmaceutical compositions.

2. Background of the Invention

Decreased circulating estradiol levels occur with senescence of theovaries and reduced follicular development, and cause characteristicsymptoms at menopause (Bachmann, G. A. and Nevadunsky, N. S., Am. Fam.Phys. 61:3090-3096 (2000); Beers, M. R. and Berkow, R., eds.,“Gynecology and Abstetrics,” in The Merck Manual of Diagnosis andTherapy, 17th Edition, Merck Research Laboratories, Whitehouse Station,N.J., 1942-1944 (1999)). Common symptoms include hot flashes, menstrualirregularities, night sweats, chills, insomnia, paresthesias,palpitations, tachycardia, cold hands and feet, headache, anxiety,dizziness, nervousness, depression, irritability, impaired cognition,diminished libido, fatigue, gastrointestinal symptoms, and atrophicvaginitis (Bachmann, G. A. and Nevadunsky, N. S., Am. Fam. Phys.61:3090-3096 (2000); Beers, M. R. and Berkow, R., eds., “Gynecology andAbstetrics,” in The Merck Manual of Diagnosis and Therapy, 17th Edition,Merck Research Laboratories, Whitehouse Station, N.J., 1942-1944 (1999);Semmens, J. P. and Wagner, G., J. Am. Med. Assoc. 248:445-448 (1982);Bachmann, G. A., Maturitas 22 (Suppl.):S1-S5 (1995); Greendale, G. A.,and Judd, H. L., J. Am. Geriatr. Soc. 41:426-436 (1993); Nilsson, K., etal., Maturitas 21:51-56 (1995)). Symptoms are frequently severe enoughto cause women to seek treatment and may persist for several yearsduring perimenopause and/or post-menopause.

Estrogen deprivation causes profound changes in the genitourinary tract,and up to 40% of postmenopausal women have symptoms associated withthese changes (Greendale, G. A., and Judd, H. L., J. Am. Geriatr. Soc.41:426-436 (1993)). A lack of vaginal lubrication and frequent vaginalinfections are experienced by over 50% of post-menopausal women (Rosen,R., et al., J. Sex & Marital Therapy 19:171-188 (1993); Bachmann, G. A.,Maturitas 22 (Suppl.):S1-S5 (1995)). The vaginal mucosa and vulvar skinbecome thinner, the labia flatten and shrink, and the clitoris, uterus,and ovaries decrease in size (Beers, M. R. and Berkow, R., eds.,“Gynecology and Abstetrics,” in The Merck Manual of Diagnosis andTherapy, 17th Edition, Merck Research Laboratories, Whitehouse Station,N.J. (1999), pp. 1942-1944). Vaginal pH increases from the normal3.5-4.0 (which favors lactobacilli) to 6.0-8.0 (which favors pathogenicorganisms) (Pandit, L., and Ouslander, J. G., Am. J Med. Sci.314:228-231 (1997); Semmens, J. P. and Wagner, G., J. Am. Med. Assoc.248:445-448 (1982)). Decreased pelvic muscle tone leads to urinaryfrequency, urgency, and incontinence (Bachmann, G. A., Maturitas 22(Suppl.):S1-S5 (1995)). Endocervical glandular tissue becomes lessactive and mucus secretion decreases (Bachmann, G. A., Maturitas 22(Suppl.):S1-S5 (1995)). The vaginal-epithelium becomes dry and atrophic,which causes inflammation, discomfort, itching, and dyspareunia. Thevagina becomes less distensible and elastic and is easily traumatized(Bachmann, G. A. and Nevadunsky, N. S., Am. Fam. Phys. 61:3090-3096(2000)). Cytologic examination of vaginal mucosa shows an increasedproportion of parabasal cells and a decreased proportion of superficialcells; e.g., a calculated Maturation Index score<55 (Pandit, L., andOuslander, J. G., Am. J. Med. Sci. 314:228-231 (1997); Bachmann, G. A.and Nevadunsky, N. S., Am. Fam. Phys. 61:3090-3096 (2000); Nilsson, K.,et al., Maturitas 21:51-56 (1995)). Vaginal ultrasonography of theuterine lining will typically demonstrate endometrium thinning to ≦5 mm,signifying decreased estrogen stimulation (Osmers, R., et al., Lancet335:1569-1571 (1990)).

Estrogen therapy (ET) or hormone therapy (HT), if not contraindicated,is the treatment of choice for postmenopausal women with urogenitalatrophy (Willhite, L. A. and O'Connell, M. B., Pharmacotherapy21:464-480 (2001); Rigg., L. A., Int. J. Fertil. 31:29-34 (1986)).Various forms of HT have been shown to effectively manage menopausalsigns and symptoms, including those associated with vaginal atrophy(Cardozo, I., et al., Obstet. Gynocol. 92:722-727 (1988); Beers, M. R.and Berkow, R., eds., “Gynecology and Abstetrics,” in The Merck Manualof Diagnosis and Therapy, 17th Edition, Merck Research Laboratories,Whitehouse Station, N.J., 1942-1944 (1999); Greendale, G. A., and Judd,H. L., J. Am. Geriatr. Soc. 41:426-436 (1993); Semmens, J. P. andWagner, G., J. Am. Med. Assoc. 248:445-448 (1982); Bachmann, G. A.,Maturitas 22 (Suppl.):S1-S5 (1995); Bachmann, G. A. and Nevadunsky, N.S., Am. Fam. Phys. 61:3090-3096 (2000); Nilsson, K., et al., Maturitas21:51-56 (1995); Osmers, R., et al., Lancet 335:1569-1571 (1990); Rigg.,L. A., Int. J. Fertil. 31:29-34 (1986); Marx, P., et al., Maturitas47:47-54 (2004)). Estrogen therapy decreases vaginal pH (Bachmann, G. A.and Nevadunsky, N. S., Am. Fam. Phys. 61:3090-3096 (2000)), thickens andrevascularizes the vaginal epithelium (Bachmann, G. A. and Nevadunsky,N. S., Am. Fam. Phys. 61:3090-3096 (2000)), increases the number ofsuperficial cells (thereby increasing the Maturation Index) (Pandit, L.,and Ouslander, J. G., Am. J. Med. Sci. 314:228-231 (1997)), and rapidlyreverses vaginal atrophy (Bachmann, G. A. and Nevadunsky, N. S., Am.Fam. Phys. 61:3090-3096 (2000)).

A number of therapeutic regimens for estrogen replacement therapy areknown, although many of these regimens comprise oral or transdermaladministration of estrogens. For example, administration of conjugatedequine estrogens, estradiol, and estriol vaginal creams has been shownto restore vaginal cytology to a premenopausal state and to improveurogenital atrophy (Willhite, L. A. and O'Connell, M. B.,Pharmacotherapy 21:464-480 (2001)). The cyclic administration ofconjugated estrogens daily for three weeks followed by one week off hasbeen proposed (PREMARIN® Vaginal Cream package insert, revised Apr. 28,2004, Wyeth Pharmaceuticals, Inc., Philadelphia, Pa.). However, resultsof the Women's Health Initiative (WHI) Study led to FDA recommendationsthat women receiving estrogen therapy be exposed to the lowest effectivedose for the shortest duration of treatment (Hulley and Grady, J. Am.Med. Assoc. 291:1769-71 (2004)). Thus, the use of a less frequent dosingregimen for locally administered estrogen replacement therapy hasparticular appeal.

BRIEF SUMMARY OF THE INVENTION

The present invention is directed to an applicator comprising a singleunit-dose of a monophasic pharmaceutical composition comprising aconjugated estrogen and a hydrophilic or lipophilic excipient, whereinthe composition has a viscosity greater than about 1 Poise and less thanabout 30,000 Poise.

In some embodiments, the conjugated estrogen comprises two or moreconjugated estrogens.

In some embodiments, the conjugated estrogen comprises sodium estronesulfate, sodium equilin sulfate, sodium 17α-dihydroequilin sulfate,sodium 17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate, or acombination thereof.

In some embodiments, the conjugated estrogen comprises sodium estronesulfate, sodium equilin sulfate, sodium 17α-dihydroequilin sulfate,sodium 17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate,sodium Δ8,9-dehydroestrone sulfate, or a combination thereof.

In some embodiments, the conjugated estrogen consists of a combinationof sodium estrone sulfate, sodium equilin sulfate, sodium17α-dihydroequilin sulfate, sodium 17β-dihydroequilin sulfate, sodium17α-estradiol sulfate, sodium 17β-estradiol sulfate, sodium equileninsulfate, sodium 17α-dihydroequilenin sulfate, and sodium17β-dihydroequilenin sulfate.

In some embodiments, the conjugated estrogen consists of a combinationof sodium estrone sulfate, sodium equilin sulfate, sodium17α-dihydroequilin sulfate, sodium 17β-dihydroequilin sulfate, sodium17α-estradiol sulfate, sodium 17β-estradiol sulfate, sodium equileninsulfate, sodium 17α-dihydroequilenin sulfate, sodium17β-dihydroequilenin sulfate, and sodium Δ8,9-dehydroestrone sulfate.

In some embodiments, the composition comprises a hydrophilic phase. Infurther embodiments, the composition comprises a pharmaceuticallyacceptable hydrophilic excipient selected from the group consisting ofwater, glycerin, propylene glycol, polyethylene glycol, polyol, alcohol,and combinations thereof.

In some embodiments, the composition comprises a lipophilic phase. Infurther embodiments, the composition comprises a pharmaceuticallyacceptable lipophilic excipient selected from the group consisting ofglyceryl esters of fatty acids, monoglycerides, diglycerides,triglycerides, and combinations thereof. In some embodiments, thecomposition comprises a glyceryl esters of fatty acids with carbon chainlengths of 4 to 24, and combinations thereof. In some embodiments, thecomposition comprises a pharmaceutically acceptable lipophilic excipientselected from the group consisting of lauric acid, palmitic acid, oleicacid, linoleic acid, linolenic acid, stearic acid, myristic acid, andcombinations thereof.

In some embodiments, the composition comprises a pharmaceuticallyacceptable excipient selected from the group consisting of an alkalineagent, a stabilizer, an adhesion agent, a solvent, a surfactant, ahumectant, a buffering agent, and combinations thereof.

In some embodiments, the composition comprises a pharmaceuticallyacceptable excipient, wherein the excipient is an alkaline agent. Thealkaline agent can be an inorganic base selected from the groupconsisting of hydroxides and oxides of alkali metals, alkaline earthmetals, and combinations thereof. The alkaline agent can be an organicbase comprising an amine.

In some embodiments, the composition comprises a pharmaceuticallyacceptable excipient, wherein the excipient is a stabilizer. Thestabilizer can be selected from the group consisting of methyl paraben,propyl paraben, t-butyl hydroquinone, butylated hydroxyanisole,butylated hydroxytoluene, ascorbic acid and its esters, vitamin E andits esters, sodium bisulfite, sodium metabisulfite, 3-dehydroshikimicacid, tocopherols and their esters, alkyl gallates, chelating agents,EDTA, edetate disodium, citric acid, benzyl alcohol, and combinationsthereof.

In some embodiments, the composition comprises a pharmaceuticallyacceptable excipient, wherein the excipient is an adhesion agent. Theadhesion agent can be selected from the group consisting of hydrogenatedvegetable oil, polyethylene glycol, cetyl alcohol, cetyl esters wax,microcrystalline wax, paraffin, ethyl alcohol, stearyl alcohol, laurylalcohol, myristal alcohol, cetostearyl alcohol, white wax, yellow wax,beeswax, candelilla wax, cotton wax, camauba wax, bayberry wax,rice-bran wax, carbomer, hydroxypropylmethylcellulose, hypromellose,starch, methylcellulose, microcrystalline cellulose, and combinationsthereof.

In some embodiments, the composition comprises a pharmaceuticallyacceptable excipient, wherein the excipient is a solvent. The solventcan be selected from the group consisting of water, glycerin, dehydratedalcohol, glyceryl esters of fatty acids, lauryl macrogolglycerides,polyoxyethylene alkyl ethers, and combinations thereof.

In some embodiments, the composition comprises a pharmaceuticallyacceptable excipient, wherein the excipient is a surfactant. Thesurfactant can be selected from the group consisting of sodium laurylsulfate, polysorbate 80, poloxamer, lauryl macrogolglycerides,polyoxyethylene alkyl ethers, and combinations thereof.

In some embodiments, the composition comprises a pharmaceuticallyacceptable excipient, wherein the excipient is a humectant. Thehumectant can be selected from the group consisting of polyethyleneglycol, propylene glycol, glycerin, polyol, polyol derivatives, andcombinations thereof.

In some embodiments, the composition comprises a pharmaceuticallyacceptable excipient, wherein the excipient is a buffering agent. Thebuffering agent can be selected from the group consisting of Trisbuffers, Tris EDTA, Tris acetate, Tris phosphate, Tris glycine,phosphate buffers, sodium phosphate, sodium phosphate dibasic, potassiumphosphate, bicarbonate buffers, acetate buffers, ammonium buffers,citrate buffers, organic acid buffers, zwitterionic buffers, andderivatives and combinations thereof.

In some embodiments, the composition is substantially free of ethanol.

In some embodiments, the composition comprises conjugated estrogen in asingle unit-dose, wherein the conjugated estrogen is an amount of about0.1 mg to about 10 mg. In some embodiments, the composition is a singleunit-dose in an amount of about 100 mg to about 5 g. In someembodiments, the composition comprises conjugated estrogen in a singleunit-dose, wherein the conjugated estrogen is an amount of about 0.1 mgto about 10 mg, wherein the total composition is an amount of about 100mg to about 5 g.

In some embodiments, the composition comprises conjugated estrogen in aconcentrated single unit-dosage form, wherein the conjugated estrogen isin an amount of about 0.02% to about 5% of the total weight of thecomposition.

In some embodiments, the composition comprises conjugated estrogen in aconcentrated single unit-dosage form, wherein the conjugated estrogen isan amount of about 1 mg to about 10 mg of the total composition. In someembodiments, the composition is a single unit-dose in an amount of about100 mg to about 2 g. In some embodiments, the composition comprisesconjugated estrogen in a concentrated single unit-dosage form, whereinthe conjugated estrogen is an amount of about 1 mg to about 10 mg of thetotal composition, wherein the total composition is an amount of about100 mg to about 2 g.

The present invention is further directed to a monophasic pharmaceuticalcomposition comprising a conjugated estrogen and a lipophilic orhydrophilic excipient, wherein the composition has a viscosity greaterthan about 1 Poise and less than about 30,000 Poise, and wherein thecomposition is capable of a percent area of spread up to about 90% overthe estimated human vaginal surface area.

The present invention is further directed to a monophasic pharmaceuticalcomposition comprising a conjugated estrogen and a lipophilic orhydrophilic excipient, wherein the composition has a viscosity greaterthan about 1 Poise and less than about 30,000 Poise, and wherein thediffusion of estrone or equilin from the composition across a celluloseacetate membrane is from about 60% to about 90% at 6 hours.

The present invention is further directed to a monophasic pharmaceuticalcomposition comprising a conjugated estrogen and a lipophilic orhydrophilic excipient, wherein the composition has a viscosity greaterthan about 1 Poise and less than about 30,000 Poise, and wherein thediffusion of estrone or equilin from the composition across humanvaginal tissue is from about 30% to about 90% at 24 hours.

The present invention is further directed to a kit comprising one ormore applicators, wherein each applicator comprises a single unit-doseof a monophasic pharmaceutical composition comprising a conjugatedestrogen and a lipophilic or hydrophilic excipient, wherein thecomposition has a viscosity greater than about 1 Poise and less thanabout 30,000 Poise.

In some embodiments, the kit comprises a vaginal applicator.

In some embodiments, the kit comprises an oral applicator.

In some embodiments, the kit further comprises printed instructions foruse of the kit.

The present invention is further directed to a vaginal applicatorcomprising a single unit-dose of a monophasic pharmaceutical compositioncomprising a conjugated estrogen and a lipophilic or hydrophilicexcipient, wherein the composition has a viscosity greater than about 1Poise and less than about 30,000 Poise.

The present invention is further directed to an oral applicatorcomprising a single unit-dose of a monophasic pharmaceutical compositioncomprising and a lipophilic or hydrophilic excipient, wherein thecomposition has a viscosity greater than about 1 Poise and less thanabout 30,000 Poise. In further embodiments, the oral applicator appliesthe composition as a spray.

The present invention is further directed to a method of treating amenopausal condition in a female in need thereof, the method comprisingadministering to the female a single unit-dose of a monophasicpharmaceutical composition comprising a conjugated estrogen and alipophilic or hydrophilic excipient, wherein the composition has aviscosity greater than about 1 Poise and less than about 30,000 Poise.

In some embodiments, the method further comprises transmucosaladministration.

In some embodiments, the composition is administered at least once dailyfor at least 2 consecutive days.

In some embodiments, the composition is administered at least once dailyfor at least 7 consecutive days.

In some embodiments, the composition is administered at least twice perweek for at least 1 week.

In some embodiments, the composition is administered at least twice perweek for at least 2 weeks.

In some embodiments, the composition is administered (a) at least oncedaily for at least 7 consecutive days, then (b) at least twice per weekfor at least 2 weeks.

In some embodiments, the composition is administered (a) at least oncedaily for 2 to 13 consecutive days, then (b) at least twice per week forat least 2 weeks.

In some embodiments, the menopausal condition is selected from the groupconsisting of vaginal dryness, pain during intercourse, increased riskof infections, inability to control urination (incontinence), increasedfrequency of urinary infections, vaginal atrophy, kraurosis vulvae, hotflashes and night sweats, fatigue, emotional changes (mood swings andchanges in sexual interest), sleep disturbances (insomnia), drier skinand hair, increased growth of facial and body hair, aches and pains inthe joints, headaches, palpitations (rapid, irregular heart beats),vaginal itching, osteoporosis, and generalized itching.

In some embodiments, the method provides systemic treatment of themenopausal condition.

The present invention is further directed to a method of delivering to afemale in need thereof an applicator comprising a single-unit dose of amonophasic pharmaceutical composition comprising a conjugated estrogenand a lipophilic or hydrophilic excipient, wherein the composition has aviscosity greater than about 1 Poise and less than about 30,000 Poise,the method comprising: (a) registering in a computer readable storagemedium identity of a physician permitted to prescribe the applicator;(b) providing the female with counseling information concerning a riskattendant to the applicator; (c) obtaining informed consent of thefemale to receive the composition despite the risk; (d) registering thefemale in the computer readable medium after obtaining the informedconsent; and (e) permitting the female access to the applicator.

BRIEF DESCRIPTION OF THE DRAWINGS/FIGURES

FIG. 1 shows the stability profiles of estrone (FIG. 1A) and equilin(FIG. 1B) over four weeks at 60° C. in aqueous-based (▴), glycerin-based(▪), and Gelucire®-based (●) formulations containing ConjugatedEstrogens, USP (Type DE, 525 mg/g).

FIG. 2 shows the stability profiles of the sum ofestrone+equilin+17α-dihydroequilin (FIG. 2A) and equilenin (FIG. 2B)over four weeks at 60° C. in aqueous-based (▴), glycerin-based (▪), andGelucire®-based (●) formulations containing Conjugated Estrogens, USP(Type DE, 525 mg/g).

FIG. 3 shows the stability profiles of estrone (FIG. 3A) and equilin(FIG. 3B) over four weeks at 60° C. in aqueous-based (▴), glycerin-based(▪), and Gelucire®-based (●) formulations containing ConjugatedEstrogens (37.5 mg/g).

FIG. 4 shows the stability profiles of the sum ofestrone+equilin+17α-dihydroequilin (FIG. 4A) and equilenin (FIG. 4B)over four weeks at 60° C. in aqueous-based (▴), gylcerin-based (▪), andGelucire®-based (●) formulations containing Conjugated Estrogens (37.5mg/g).

FIG. 5 shows in vitro diffusion of estrone (FIG. 5A) and equilin (FIG.5B) against cellulose acetate membranes for aqueous-based (♦) andgylcerin-based (▪) formulations containing Conjugated Estrogens (37.5mg/g).

FIG. 6 provides a diagram of a methodology for measuring the in vitrodiffusion of conjugated estrogens formulations across normal humanvaginal ectocervical tissue.

FIG. 7 shows the in vitro diffusion of estrone against normal humanvaginal ectocervical tissue of a glycerin-based (♦) formulationcontaining Conjugated Estrogens (37.5 mg/g) as compared with Premarin®cream (▴).

FIG. 8 shows the in vitro diffusion of estrone against normal humanvaginal ectocervical tissue of aqueous-based (▪) and glycerin-based (●)formulations containing Conjugated Estrogens, USP (Type DE, 525 mg/g) ascompared with Premarin® cream (▴).

FIG. 9 provides a manufacturing process flow chart for conjugatedestrogens aqueous-based, glycerin-based, and Gelucire®-basedformulations prepared from Conjugated Estrogens, USP (Type DE, 525mg/g).

FIG. 10 shows the in vitro diffusion of estrone against normal humanvaginal ectocervical tissue of aqueous-based (▴), glycerin-based (◯),and Gelucire®-based (X) ethanol-free formulations prepared fromConjugated Estrogens, USP (Type DE, 525 mg/g) as compared with aglycerin-based (□) ethanol-containing formulation prepared fromConjugated Estrogens, USP (Type DE, 525 mg/g), an estrone standardsolution (●), and Premarin® cream (▪).

DETAILED DESCRIPTION OF THE INVENTION

Pharmaceutical Compositions

The present invention is directed to applicators, monophasicpharmaceutical compositions, and kits comprising a conjugated estrogenand a hydrophilic or lipophilic excipient, and methods for using thesame. The embodiments and definitions described are intended toillustrate the invention and are not intended to limit the scope of theinvention. In some embodiments, the present invention is directed tomonophasic pharmaceutical compositions comprising two or more conjugatedestrogens and a lipophilic or hydrophilic excipient. In someembodiments, at least a fraction of at least one conjugated estrogen ispresent in the composition in a molecular dispersion.

“Monophasic” compositions as described herein are compositions derivedfrom a single liquid phase. One of skill in the art will readilyunderstand that a composition can be derived from a liquid phase, withmovement of the liquid phase restricted by components that increase theviscosity or rigidity of the composition. In some embodiments, thesingle liquid phase comprises one or more liquids that are lipophilic.In some embodiments the single liquid phase comprises one or moreliquids that are hydrophilic. In some embodiments the single liquidphase comprises one or more liquids that are amphipathic. In someembodiments the single liquid phase comprises one or more liquids thatare a combination of hydrophilic, lipophilic, and amphipathic liquidsthat yields a single liquid phase. Creams (e.g., Premarin® conjugatedequine estrogens vaginal cream) containing at least two distinct liquidphases, such as an oil phase and a water phase, are not “monophasic” asintended herein. Rather, such creams are biphasic systems in which thedrug is dispersed in one phase (generally a water phase) and theexcipients are dispersed in another phase (generally an oil phase). Thisrequires preparation of two separate phases and the use of emulsifiersfor mixing the incompatible phases into a single composition (anemulsion). The phases remain physically and chemically distinct withinthe emulsion, which is often unstable upon variations in temperature orother physical parameters. In contrast with emulsions, monophasicsystems comprise compatible components in a single phase. The term“monophasic” as used herein also encompasses solutions or suspensions inwhich components are dispersed within a single liquid phase. In someembodiments, the monophasic compositions described herein can comprise amolecular dispersion (a true solution) of one or more components. Insome embodiments, the monophasic compositions described herein cancomprise a molecular dispersion of at least a fraction of one or morecomponents. Thus, a fraction rather than the entirety of an amount of aparticular component can be present in a molecular dispersion. In someembodiments, the monophasic compositions described herein comprise amolecular dispersion of at least a fraction of at least one conjugatedestrogen. In some embodiments, the monophasic compositions describedherein can comprise one or more colloidal dispersions or coarsedispersions, depending on the particle size of the dispersed componentsas understood by one skilled in the art. In some embodiments, themonophasic compositions described herein can comprise any combination ofmolecular, colloidal, and coarse dispersions. In some embodiments, themonophasic compositions described herein can comprise a particularcomponent as any combination of molecular, colloidal, and coarsedispersions. Components dispersed within the monophasic composition canbe lipophilic, hydrophilic, amphipathic, or combinations thereof.

In some embodiments, the viscosity of the compositions can be adjustedto improve retention of the compositions at sites of application.Viscosity can be adjusted by excipients known in the art, includingadhesion agents as described herein. In some embodiments, the viscositycan be greater than about 1.0 Poise (P) and less than about 30,000 P. Insome embodiments, the viscosity of the composition at sites ofapplication can be greater than about 1.0 P and less than about 20,000P. In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 2.5 P and less than about 10,000P. In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 10 P and less than about 5000 P.In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 50 P and less than about 30,000 P.In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 50 P and less than about 2,500 P.In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 50 P and less than about 2,000 P.In some embodiments the viscosity of the composition at sites ofapplication can be greater than about 90 P and less than about 30,000 P.In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 90 P and less than about 2,500 P.In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 90 P and less than about 2,000 P.In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 250 P and less than about 2,000 P.In some embodiments, the viscosity of the composition at sites ofapplication can be greater than about 500 P and less than about 2,000 P.

In some embodiments, the compositions of the present invention arebioadhesive, with prolonged retention at the site of application. Insome embodiments, the compositions are bioadhesive, with prolongedretention when applied vaginally. In further embodiments, thecompositions are applied vaginally with greater ease, with lessdripping. In some embodiments, the compositions are applied vaginallyand are associated with greater comfort due to less dripping. In someembodiments, the compositions are associated with greater comfort due toa soothing and emollient effect. In some embodiments, the compositionsallow for greater patient compliance with prescribed administrationprocedures due to greater comfort.

In some embodiments, the compositions demonstrate improved spreadabilityas compared with existing formulations. In some embodiments,spreadability is measured by the percent area of spread (% spread) ofthe compositions as compared to the surface area of the site ofadministration. In some embodiments, spreadability is measured by the %spread of the compositions as compared to the estimated human vaginalsurface area. In some embodiments, the compositions are capable of a %spread up to about 90% of the estimated human vaginal surface area. Insome embodiments, the compositions are capable of a % spread up to about80% of the estimated human vaginal surface area. In some embodiments,the compositions are capable of a % spread up to about 70%, 71%, or 72%of the estimated human vaginal surface area. In some embodiments,prolonged retention, bioadhesiveness, improved comfort, and combinationsof such characteristics are associated with the % spread of thecompositions.

In some embodiments, the compositions demonstrate physical stability asdetermined by characteristics including, but not limited to, appearance,pH, and viscosity at higher temperature and/or higher humidity forextended durations. In some embodiments, the compositions demonstratechemical stability as determined by characteristics including, but notlimited to, the chemical stability of conjugated estrogens at highertemperature and/or higher humidity. In some embodiments the chemicalstability of conjugated estrogens in the compositions is determined bythe ratio of equilin to estrone. In some embodiments, the ratio ofequilin to estrone in the compositions remains substantially constant athigher temperature and/or higher humidity. In some embodiments, physicalstability and/or chemical stability of the compositions is demonstratedover a period of greater than one year at higher temperature and/orhigher humidity. In some embodiments, physical stability and/or chemicalstability of the compositions is demonstrated over a period of one yearat higher temperature and/or higher humidity. In some embodiments,physical stability and/or chemical stability of the compositions isdemonstrated over a period of 6 months at higher temperature and/orhigher humidity. In some embodiments, physical stability and/or chemicalstability of the compositions is demonstrated over a period of 3 monthsat higher temperature and/or higher humidity. In some embodiments,physical stability and/or chemical stability of the compositions isdemonstrated over a period of one month at higher temperature and/orhigher humidity. In some embodiments, physical stability and/or chemicalstability of the compositions is demonstrated over a period of one, two,three, or four weeks of higher temperature and/or higher humidity. Insome embodiments, physical stability and/or chemical stability of thecompositions is measured at 60° C. In some embodiments, physicalstability and/or chemical stability of the compositions is measured at40° C. and 75% relative humidity.

Various conjugated estrogens can be used within the scope of thecompositions described herein. An estrogen is any of various naturalsteroids or synthetic steroids that stimulate the development of femalesecondary sex characteristics and promote the growth and maintenance ofthe female reproductive system; or any other compound that mimics thephysiological effect of natural estrogens. Examples of estrogens are setforth in U.S. Pat. Nos. 5,908,638, 6,855,703, and 6,660,726, which arecommonly assigned to the assignee of the present invention, thedisclosures of which are incorporated by reference herein in theirentireties. Suitable estrogens include estrone, 17α-estradiol,17β-estradiol, equilin, 17α-dihydroequilin, 17β-dihydroequilin,equilenin, 17α-dihydroequilenin, 17β-dihydroequilenin,Δ^(8,9)-dehydroestrone, 17α-Δ^(8,9)-dehydroestradiol,17β-Δ^(8,9)-dehydroestradiol, ethinyl estradiol, estradiol valerate,6-OH equilenin, 6-OH 17α-dihydroequilenin, 6-OH 17β-dihydroequilenin,and mixtures, and salts thereof, and the estrogen ketones and theircorresponding 17α- and 17β-hydroxy derivatives. The term “conjugated” asdescribed herein refers to various conjugates understood by thoseskilled in the art, including, but not limited to, sulfate esters,glucuronide esters, or mixed sulfate-glucuronide esters of an estrogen.In some embodiments, the estrogens are present as salts of estrogenconjugates. Pharmaceutically suitable salts can be various saltsunderstood by those skilled in the art, including, but not limited to,sodium salts, calcium salts, magnesium salts, lithium salts, piperazinesalts, and 2-amino-2-(hydroxymethyl)-1,3-propanediol (Tris) salts.

In some embodiments, the composition of the present invention comprisesa conjugated estrogen such as, but not limited to, sodium estronesulfate, sodium equilin sulfate, sodium 17α-dihydroequilin sulfate,sodium 17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate, or acombination thereof. In some embodiments, the composition of the presentinvention comprises a conjugated estrogen such as, but not limited to,sodium estrone sulfate, sodium equilin sulfate, sodium17α-dihydroequilin sulfate, sodium 17β-dihydroequilin sulfate, sodium17α-estradiol sulfate, sodium 17β-estradiol sulfate, sodium equileninsulfate, sodium 17α-dihydroequilenin sulfate, sodium17β-dihydroequilenin sulfate, sodium Δ8,9-dehydroestrone sulfate, or acombination thereof. In some embodiments, the composition of the presentinvention comprises a conjugated estrogen such as, but not limited to,sodium ethinyl estradiol sulfate. In some embodiments, the conjugatedestrogen is sodium ethinyl estradiol sulfate. In some embodiments, theconjugated estrogen is a mixture of 9 synthetic estrogens, such as,e.g., the mixture of estrogens found in CENESTIN® tablets, syntheticconjugated estrogens A (Duramed Pharmaceuticals, Inc., Pomona, N.Y.; seeCENESTIN® prescribing information, revised February 2004). In someembodiments, the conjugated estrogen is a mixture of 10 syntheticestrogens; e.g., the mixture of estrogens found in ENJUVIA®, syntheticconjugated estrogens B (Endeavor Pharmaceuticals, Inc., Wilmington,N.C.; see ENJUVIA® package insert, revised May 4, 2004).

In some embodiments, the composition of the present invention comprisesconjugated estrogens, wherein the conjugated estrogens consist of acombination of sodium estrone sulfate, sodium equilin sulfate, sodium17α-dihydroequilin sulfate, sodium 17β-dihydroequilin sulfate, sodium17α-estradiol sulfate, sodium 17β-estradiol sulfate, sodium equileninsulfate, sodium 17α-dihydroequilenin sulfate, and sodium17β-dihydroequilenin sulfate. In some embodiments, the composition ofthe present invention comprises conjugated estrogens, wherein theconjugated estrogens consist of a combination of sodium estrone sulfate,sodium equilin sulfate, sodium 17α-dihydroequilin sulfate, sodium17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate, andsodium Δ8,9-dehydroestrone sulfate.

In some embodiments, the composition of the present invention consistsessentially of a conjugated estrogen, including one or more conjugatedestrogens. In some embodiments, the composition of the present inventionconsists essentially of conjugated estrogens, wherein the conjugatedestrogens consist of a combination of sodium estrone sulfate, sodiumequilin sulfate, sodium 17α-dihydroequilin sulfate, sodium17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, and sodium 17β-dihydroequilenin sulfate.In some embodiments, the composition of the present invention consistsessentially of conjugated estrogens, wherein the conjugated estrogensconsist of a combination of sodium estrone sulfate, sodium equilinsulfate, sodium 17α-dihydroequilin sulfate, sodium 17β-dihydroequilinsulfate, sodium 17α-estradiol sulfate, sodium 17β-estradiol sulfate,sodium equilenin sulfate, sodium 17α-dihydroequilenin sulfate, sodium17β-dihydroequilenin sulfate, and sodium Δ8,9-dehydroestrone sulfate.

In some embodiments, the composition of the present invention issubstantially devoid of impurities present in naturally derivedconjugated equine estrogens, including, but not limited to, indican,sulfated benzyl alcohol, hippuric acid, benzoic acid, and creatinine andas described in U.S. Pat. No. 6,855,703.

In some embodiments, the composition of the present invention issubstantially free of ethanol.

In some embodiments, the composition of the present invention furthercomprises a pharmaceutically acceptable excipient. As used herein,“excipient” refers to a component, or mixture of components, that isused in the formulation of the compositions of the present invention togive desirable characteristics to the composition. As used herein, theterm “pharmaceutically acceptable” refers to those compounds, materials,compositions, and/or dosage forms which are, within the scope of soundmedical judgment, suitable for contact with the tissues of human beingsand animals without excessive toxicity, irritation, allergic response,or other problematic complications over the desired duration oftreatment commensurate with a reasonable benefit/risk ratio. In someembodiments, the term “pharmaceutically acceptable” means approved by aregulatory agency of the Federal or a state government or listed in theU.S. Pharmacopeia or other generally recognized internationalpharmacopeia for use in animals, and more particularly in humans.Various pharmaceutically acceptable excipients can be used. In someembodiments, the pharmaceutically acceptable excipient can be, but isnot limited to, an alkaline agent, a stabilizer, an adhesion agent, asolvent, a surfactant, a humectant, a buffering agent, a filler, anemollient, or combinations thereof. Excipients in addition to thosediscussed herein can include excipients listed in, though not limitedto, Garg, S. et al. Pharm. Tech. 25(2):1-14 (2001) and references citedtherein and in Remington: The Science and Practice of Pharmacy, 21^(st)ed. (2005). Inclusion of an excipient in a particular classificationherein (e.g., “solvent”) is intended to illustrate rather than limit therole of the excipient. A particular excipient can actually fall withinmultiple classifications.

The term “alkaline agent” refers to any substance utilized for itsalkaline properties and includes any pharmaceutically acceptablematerial that can increase the pH of a medium. In some embodiments thealkaline agent is an inorganic base. In some embodiments, the alkalineagent is an inorganic base such as hydroxides, oxides, or combinationsthereof of alkali metals, alkaline earth metals, or combinationsthereof. Suitable alkali metals and alkaline earth metals include, butare not limited to, lithium, potassium, calcium, magnesium, and sodium.In some embodiments, the alkaline agent is an organic base. In someembodiments, the alkaline agent is an organic base such as a primaryamine, a secondary amine, a tertiary amine, ammonium hydroxide, orcombinations thereof. In some embodiments, the alkaline agent is anorganic base such as trimethylamine, triethylamine, triethanolamine, orammonium hydroxide.

The pH of the composition of the invention can be physiologicallycompatible and/or sufficient to maintain stability of the composition.In some embodiments, the composition of the present invention can have apH of about 5 to about 9, or a pH of about 6 to about 8.Pharmaceutically acceptable acids and bases known in the art can beutilized to adjust pH. In some embodiments, pharmaceutically acceptableacids and bases include sodium hydroxide and hydrochloric acid.

Stability of a pharmaceutical composition is one factor determining thefrequency of application required to elicit a therapeutic effect. Giventhe latter, a more stable pharmaceutical composition for estrogenreplacement therapy would be particularly beneficial. Variousstabilizers can be used in the present invention. The term “stabilizer”refers to any substance that keeps a component of the compositionchemically stable. Alternatively, the term “stabilizer” refers to anysubstance that slows or retards the degradation or alteration of acomponent of the composition. For example, a stabilizer can protect anestrogen from instability caused by light, moisture, heat, hydrolysis,or oxidation. In some embodiments, the stabilizer is lipophilic. In someembodiments, the stabilizer is hydrophilic. In some embodiments, thestabilizer can be, but is not limited to, methyl paraben, propylparaben, t-butyl hydroquinone, butylated hydroxyanisole (BHA), butylatedhydroxytoluene (BHT), ascorbic acid and its esters, vitamin E and itsesters (e.g., vitamin E acetate), sodium bisulfite, sodiummetabisulfite, 3-dehydroshikimic acid (DHS), tocopherols and theiresters, alkyl gallates, chelating agents, EDTA(ethylenediaminetetraacetic acid; edetate disodium), citric acid, benzylalcohol, or combinations thereof. In some embodiments, the stabilizercan be methyl paraben, propyl paraben, edetate disodium, butylatedhydroxyanisole, butylated hydroxytoluene, or combinations thereof.

The term “adhesion agent” refers to a substance, or mixture ofsubstances, added to improve retention and/or bioavailability of thecompositions. The adhesion agent can be hydrophilic (e.g., variouscarbomers, including Carbopol® 934P and 974P, as well ascarboxymethylcellulose, hydroxypropylmethylcellulose, includinghypromellose 2208, alginate, and polyethylene glycol). In someembodiments, the adhesion agent has low hydrophilic-lipophilic balance(HLB). In some embodiments, the HLB value is less than 7. In someembodiments, the HLB value is less than 5. In some embodiments, the HLBvalue is about 4. Examples of suitable adhesion agents include, but arenot limited to, hydrogenated vegetable oil, ethyl alcohol, cetylalcohol, cetyl esters wax, microcrystalline wax, paraffin, stearylalcohol, lauryl alcohol, myristyl alcohol, cetostearyl alcohol, whitewax, yellow wax, beeswax, candelilla wax, cotton wax, camauba wax,bayberry wax, rice-bran wax, starch, methylcellulose, microcrystallinecellulose, and combinations thereof. In some embodiments, the adhesionagent is a mixture of cetyl esters wax, cetyl alcohol, and beeswax.

The term “solvent” refers to any substance capable of dissolving ordispersing one or more of the conjugated estrogens or excipients of thepresent invention. The solvent can be aqueous or non-aqueous. Thesolvent can be hydrophilic, lipophilic, or amphipathic. In someembodiments a solvent is amphipathic and is associated with additionallipophilic or hydrophilic solvents in a monophasic composition asdescribed herein. In some embodiments, the solvent is water, a polyol(e.g., glycerol), glyceryl esters of fatty acids, or laurylmacrogolglycerides (e.g., Gelucire®-based 44/14).

The term “surfactant” refers to any substance that lowers the surfacetension of a pharmaceutical composition of the invention. In someembodiments, the surfactant includes, but is not limited to, sodiumlauryl sulfate, polysorbate 80, poloxamer, lauryl macrogolglycerides,polyoxyethylene alkyl ethers, and combinations thereof.

The term “humectant” refers to any substance that promotes retention ofmoisture in the composition of the present invention. In someembodiments, the humectant includes, but is not limited to, polyethyleneglycol, propylene glycol, glycerin, polyol, polyol derivatives, andcombinations thereof.

The term “buffering agent” refers to any substance capable ofneutralizing both acids and bases and thereby maintaining the desired pHof the composition of the present invention. In some embodiments, thebuffer can be, but is not limited to, Tris buffers (Tris EDTA (TE), Trisacetate (TAE), Tris phosphate (TPE), Tris glycine), phosphate buffers(e.g., sodium phosphate, potassium phosphate), bicarbonate buffers,acetate buffers (e.g., sodium acetate), ammonium buffers, citratebuffers, and derivatives and combinations thereof. In some embodiments,an organic acid buffer is used. In some embodiments, an acetate buffer,a phosphate buffer, or a citrate buffer can be used. In someembodiments, a zwitterionic buffer can be used. In some embodiments, thebuffering agent is a phosphate buffer (e.g., sodium phosphate dibasic).

As defined herein, an “emollient” is a substance that moisturizes andincreases the pliability of a treated epithelium. In some embodiments,the emollient can be, but is not limited to, lanolin, isopropylmyristate, palmitate, oleyl alcohol, beeswax, mineral oil, silicone oil,or combinations thereof.

As defined herein, a “filler” is a substance used to give bulk to thecomposition without chemically reacting with the conjugated estrogens ofthe present invention. Fillers are known to those in the art, see e.g.,Remington: The Science and Practice of Pharmacy, 21^(st) ed. (2005).

Acceptable excipients associated with a hydrophilic phase of thedescribed monophasic compositions include, but are not limited to water,glycerin, polyethylene glycol, polyols, alcohols, and combinationsthereof.

Acceptable excipients associated with a lipophilic phase of thedescribed monophasic compositions include, but are not limited tomonoglycerides, diglycerides, triglycerides, esters of glycerol(1,2,3-propanetriol) and fatty acids and include lipophilic liquids suchas oils. In some embodiments, the pharmaceutical compositions describedherein comprise glyceryl esters of fatty acids comprised of hydrocarbonchain lengths of 4 or more carbons. In some embodiments, eachhydrocarbon chain can contain 4 to 36 carbon atoms. In some embodiments,each hydrocarbon chain can contain 4 to 24 carbon atoms. In someembodiments, the hydrocarbon chains can contain a variety of functionalgroups. In some embodiments, the hydrocarbon chain can be branched. Insome embodiments, the hydrocarbon chains are unsaturated orpolyunsaturated. In some embodiments, the hydrocarbon chains aresaturated. The degree of saturation can affect the physical state, forexample viscosity, of the lipophilic excipient. In some embodiments, thelipophilic excipient is lauric acid, myristic acid, palmitic acid,stearic acid, behenic acid, oleic acid, 12-hydroxystearic acid,undecylenic acid, tall acid, lanolin fatty acid, isostearic acid,linoleic acid, linolenic acid, or combinations thereof. In someembodiments, the lipophilic excipient can be, but is not limited to,vegetable, nut, or seed oils (e.g., almond oil, castor oil, coconut oil,corn oil, cotton seed oil, jojoba oil, linseed oil, grape seed oil, rapeseed oil, mustard oil, olive oil, palm and palm kernel oil, peanut oil,safflower oil, sesame oil, soybean oil, sunflower-seed oil, crambe oil,wheat germ oil, or cocoa butter), hydrocarbon or petroleum oils (e.g.,petrolatum, mineral oil, or liquid paraffin). In some embodiments, theoil is not an ester of glycerol, e.g., mineral oil and silicone oil.

The amount of active agent or agents in a dosage form can vary. Theexact dosage amount can be selected depending upon the needs of thepatient to which the active agent is being administered, as determinedby a relevant person. In some embodiments, one of skill in the art canperform pharmacokinetic studies and use the results of the study toadjust the dosage amount for a female, or a group of females, to asuitable level. In some embodiments, one of skill in the art candetermine an appropriate dosage amount based on varying dosage amountsand comparing to symptomatic relief. In some embodiments, appropriateanimal studies can be performed to determine an appropriate dosageamount. A “relevant person” as used herein, includes, for example, aphysician, physician assistant, nurse practitioner, pharmacist, andcustomer service representative.

In some embodiments, the composition of the present invention is in adosage form, wherein the dosage form comprises conjugated estrogen in anamount comprising about 0.1 mg/dose to about 15 mg/dose, about 0.5mg/dose to about 12 mg/dose, or about 1.0 mg/dose to about 10.0 mg/doseof conjugated estrogen. In some embodiments, the composition of thepresent invention is in a dosage form, wherein the dosage form comprisesa total amount of the pharmaceutical composition in an amount comprisingabout 50 mg/dose to about 7.5 g/dose, about 75 mg/dose to about 6g/dose, about 100 mg/dose to about 5 g/dose, about 100 mg/dose to about3 g/dose, about 100 mg/dose to about 1 g/dose, or about 100 mg/dose toabout 500 mg/dose of the dosage form. In some embodiments, the use ofsmaller amounts of locally administered pharmaceutical compositions forestrogen replacement therapy are desirable, wherein the total amount ofthe pharmaceutical composition is an amount comprising about 50 mg/doseto about 500 mg/dose of the dosage form. In some embodiments, the dosageform is administered in a smaller volume of product per dose.

In some embodiments, the composition of the present invention is in aconcentrated dosage form. In some embodiments the composition of thepresent invention is in a concentrated dosage form, wherein theconcentrated dosage form comprises about 50 mg/dose to about 500 mg/doseof total composition and about 1 mg/dose to about 10 mg/dose ofconjugated estrogen. In some embodiments the composition of the presentinvention is in a concentrated dosage form, wherein the concentrateddosage form comprises about 500 mg/dose of total composition and about1.0 mg/dose to about 10 mg/dose of conjugated estrogen. In someembodiments the composition of the present invention is in aconcentrated dosage form, wherein the concentrated dosage form comprisesabout 500 mg/dose of total composition and about 1.25 mg/dose ofconjugated estrogen. In some embodiments, unless a specific estrogen isidentified, amounts of “conjugated estrogens” refer to a summation ofthe amounts of three estrogens: sodium 17α-dihydroequilin sulfate,sodium estrone sulfate, and sodium equilin sulfate. In some embodiments,the dosage form comprises a conjugated estrogen equivalent to an amountof sodium estrone sulfate comprising about 25 μg/dose to about 5mg/dose, about 50 μg/dose to about 5 mg/dose, about 50 μg/dose to about2.5 mg/dose, about 50 μg/dose to about 1 mg/dose, and about 50 μg/doseto about 500 μg/dose sodium estrone sulfate. In some embodiments, thedosage form comprises a conjugated estrogen equivalent to an amount ofsodium equilin sulfate comprising about 15 μg/dose to about 5 mg/dose,about 30 μg/dose to about 5 mg/dose, about 30 μg/dose to about 3mg/dose, about 30 μg/dose to about 1 mg/dose, and about 30 μg/dose toabout 500 μg/dose sodium equilin sulfate. In some embodiments, thedosage form comprises a conjugated estrogen equivalent to an amount ofsodium 17-β estradiol sulfate comprising about 1 μg/dose to about 5mg/dose, 100 μg about 15 μg/dose to about 5 mg/dose, about 30 μg/dose toabout 5 mg/dose, about 30 μg/dose to about 3 mg/dose, about 30 μg/doseto about 1 mg/dose, about 30 μg/dose to about 500 μg/dose, and about 1μg/dose to about 100 μg/dose sodium 17-β estradiol sulfate. In someembodiments, the dosage form comprises a conjugated estrogen equivalentto an amount of sodium Δ8,9-dehydroestrone sulfate comprising about 0.2μg/dose to about 100 μg/dose, about 0.2 μg/dose to about 50 μg/dose,about 0.3 μg/dose to about 25 μg/dose, about 0.4 μg/dose to about 10μg/dose, or about 0.4 μg/dose to about 2 μg/dose of sodiumΔ8,9-dehydroestrone sulfate. In some embodiments, the composition of thepresent invention is in a dosage form, wherein the dosage form comprisesabout 1.25 mg/dose of conjugated estrogen.

In some embodiments, the compositions of the present inventiondemonstrate better diffusion and/or higher absorption of conjugatedestrogens at the site of administration or across cultured tissue ascompared with existing formulations, such as but not limited to,conjugated equine estrogen cream formulations. In some embodiments, thecompositions demonstrate better diffusion of estrone and/or equilin atthe site of administration or across cultured tissue. In someembodiments, the compositions demonstrate better diffusion of conjugatedestrogens across vaginal tissue. In some embodiments, the percentdiffusion of estrone from the compositions across vaginal tissue is fromabout 25% to about 90% at 24 hours. In some embodiments, the percentdiffusion of estrone from the compositions across vaginal tissue is fromabout 30% to about 90% at 24 hours. In some embodiments, the percentdiffusion of estrone from the compositions across vaginal tissue is fromabout 40% to about 90% at 24 hours. In some embodiments, the percentdiffusion of estrone from the compositions across vaginal tissue is fromabout 50% to about 90% at 24 hours. In some embodiments, thecompositions of the present invention demonstrate better diffusion ofconjugated estrogens across a non-living membrane as compared withexisting cream formulations. In some embodiments, the compositionsdemonstrate better of estrone and/or equilin diffusion across anon-living membrane. In some embodiments, the non-living membrane is acellulose acetate membrane. In some embodiments, the percent diffusionof estrone from the compositions across a cellulose acetate membrane is100% at 6 hours. In some embodiments, the percent diffusion of estronefrom the compositions across a cellulose acetate membrane is from about60% to about 90% at 6 hours. In some embodiments, the percent diffusionof estrone from the compositions across a cellulose acetate membrane isfrom about 80% to about 90% at 6 hours. In some embodiments, thecompositions demonstrating better diffusion and/or higher absorptionpermit a smaller dose and/or a reduced frequency of dosing.

Various types of conjugated estrogens of the present invention can bepresent in the pharmaceutical composition in varying amounts. In someembodiments, the percentage of the estrogens can be found within aboutthe ranges listed in Table 1.

TABLE 1 Estrogens* Range A Range B Range C Range D 17α-Estradiol 0%-99%0.5%-20%  1%-11%  2%-10% 17α- 0%-99%  5%-30% 7%-25% 10%-21%Dihydroequilin 17β- 0%-99%  0%-10% 0.5%-7%   0.1%-5%  DihydroequilinEstrone 0%-99% 25%-80% 40%-70%  50%-64% Equilin 0%-99% 10%-50% 15%-35% 20%-32% 17β-Estradiol 0%-99% 0%-7% 0.05%-4%   0.1%-3.5% 17α-Di- 0%-99%0%-7% 0.05%-5%   0.1%-4%  hydroequilenin 17β-Di- 0%-99% 0%-7% 0.05%-5%  0.1%-4%  hydroequilenin Equilenin 0%-99%  0%-15% 0.1%-10%  0.1%-6.5%Δ8,9-de- 0%-99% 0.1%-10%  1%-10% 1%-8% hydroestrone *all estrogensreported as the sodium salts of 3-monosulfate esters

As shown in Table 1, various combinations and amounts of conjugatedestrogens can be used in the present invention. In some embodiments, thecomposition of the present invention is in a dosage form, wherein thedosage form comprises about 1 mg/dose to about 10 mg/dose of conjugatedestrogens, wherein the conjugated estrogens consist of (a) about 2% toabout 10% by weight sodium 17α-estradiol sulfate; (b) about 10% to about21% by weight sodium 17α-dihydroequilin sulfate; (c) about 0.1% to about5% by weight sodium 17β-dihydroequilin sulfate; (d) about 50% to about64% by weight sodium estrone sulfate; (e) about 20% to about 32% byweight sodium equilin sulfate; (f) about 0.1% to about 3.5% by weightsodium 17β-estradiol sulfate; (g) about 0.1% to about 4% by weightsodium 17α-dihydroequilenin sulfate; (h) about 0.1% to about 4% byweight sodium 17β-dihydroequilenin sulfate; (i) about 0.1% to about 6.5%by weight sodium equilenin sulfate; and (j) about 1% to about 8% byweight sodium Δ8,9-dehydroestrone sulfate; or an amount of a mixture ofconjugated estrogens that provides an estrogenic effect equivalent tothat produced by the about 1 mg/dose to about 10 mg/dose of conjugatedestrogens as defined in (a)-(j).

In some embodiments, the amount of a particular estrogen can be in theranges specified in Table 2.

TABLE 2 Dosage Amounts (μg/dosage form) Estrogen* Range E Range F RangeG 17α-Estradiol 0-2500 1.0-17.5 43.75-87.5  17α-Dihydroequilin 0-250030-475  125-237.5 17β-Dihydroequilin 0-2500 1.5-87.5 6.25-43.75 Estrone0-2500 153-1550 637.5-775   Equilin 0-2500 60-775  250-387.517β-Estradiol 0-2500 1.5-50  6.25-25   17α-Dihydroequilenin 0-25000.6-125  2.5-62.5 17β-Dihydroequilenin 0-2500 0.3-37.5 1.25-18.75Equilenin 0-2500  1.5-162.5 6.25-81.25 Δ8,9-dehydroestrone 0-25001.25-125  12.5-125  *All estrogens reported as the sodium salts of the3-monosulfate esters.

The ranges listed in Table 2 for each estrogen are mutually exclusivefrom the ranges for the other estrogens.

The listed estrogens, as well as other estrogens, vary in potency fromeach other. The ranges given above are for the specified estrogen;however, if a different estrogen is employed, adjustments in the amountemployed, based on the relative potency, can be made and are well knownin the art. The correlations in potency between various estrogens areknown. See, for example, EP 0 253 607, which is hereby incorporated inits entirety by reference. Equivalent concentrations of estrogens can bedetermined using either in vitro or in vivo assay methods (Kuhl, H.,Drugs 51:188-215 (1996); Philibert, D., et al., Gynecol. Endocrinol.13:316-326 (1999); and Lundeen, S., et al., J. Steroid Biochem. Molec.Biol. 78:137-143 (2001)). When in vitro receptor binding studies areperformed to determine relative potency, the unconjugated forms of anestrogen should be used. See also, for example, Dickey, R. P.,“Contraceptive Therapy,” OBG Management Supplement (October 2000), pp.2-6. As described herein, “relative potency,” “equivalent amount,” or“amount equivalent to” can be determined by a method described by Mandelet. al. (J. Clin. Endocrinol. Metabol. 57:133-139 (1983)). Each of thesedocuments is hereby incorporated by reference in its entirety.

As used herein, “about” refers to plus or minus 10% of the indicatednumber. For example, “about 10%” indicates a range of 9% to 11%.

Methods of Treating Menopausal Conditions

In some embodiments, the present invention is directed to a method oftreating a condition that benefits from estrogen replacement therapy ina female in need thereof, the method comprising administering to thefemale a monophasic pharmaceutical composition comprising a conjugatedestrogen and a lipophilic or hydrophilic excipient. In some embodiments,the method comprises administering to the female a composition with aviscosity greater than about 1 Poise and less than about 30,000 Poise.In some embodiments, the present invention is directed to a method oftreating a menopausal condition in a female. In some embodiments, thepharmaceutical composition is administered transmucosally. In someembodiments, the pharmaceutical composition is administeredtransmucosally comprising vaginal administration. In some embodiments,the pharmaceutical composition is administered transmucosally comprisingoral administration.

The terms “treat” and “treatment” refer to both therapeutic treatmentand prophylactic or preventative measures, wherein the object is toprevent, inhibit, reverse or slow down (lessen) an undesiredphysiological condition, disorder or disease, or obtain beneficial ordesired clinical results. For purposes of this invention, beneficial ordesired clinical results include, but are not limited to, alleviation ofsymptoms; diminishment of extent of condition, disorder or disease;stabilized (i.e., not worsening) state of condition, disorder ordisease; delay in onset, or slowing, of condition, disorder or diseaseprogression; amelioration of the condition, disorder or disease state,remission (whether partial or total); or enhancement or improvement ofthe condition, disorder or disease. Treatment also includes, but is notlimited to, eliciting a cellular response that is clinicallysignificant, without excessive levels of side effects. In someembodiments, treatment involves transmucosal administration. In someembodiments, transmucosal administration involves vaginaladministration. In some embodiments, transmucosal administrationinvolves oral administration.

“Female” refers to any animal classified as a mammal which menstruates,including primates, e.g., humans. “Female” also refers to other nonhumanmammals, e.g., domestic and farm animals, and zoo, sports, and companionanimals such as household pets and other domesticated animals such as,but not limited to, cattle, sheep, ferrets, swine, horses, rabbits,goats, dogs, cats, and the like. In some embodiments, companion animalsare dogs and cats.

Treatment can occur over any pharmaceutically acceptable period. In someembodiments, the pharmaceutical composition is administered at leastonce. In some embodiments, the pharmaceutical composition isadministered at least once per day. In some embodiments, thepharmaceutical composition is administered multiple times per day, forexample, at least twice per day. In some embodiments, the pharmaceuticalcomposition is administered at least once daily for at least 2consecutive days. In some embodiments, the pharmaceutical composition isadministered at least twice per week for at least 1 week. In someembodiments, the pharmaceutical composition is administered at leastonce daily for at least 7 consecutive days. In some embodiments, thepharmaceutical composition is administered at least twice per week forat least 2 weeks. In some embodiments, the pharmaceutical composition isadministered (a) at least once daily for at least 2 consecutive days,then (b) at least twice per week for at least 2 weeks. In someembodiments, the pharmaceutical composition is administered (a) at leastonce daily for at least 7 consecutive days, then (b) at least twice perweek for at least 2 weeks. In some embodiments, the pharmaceuticalcomposition is administered (a) at least once daily for 2 to 13consecutive days, then (b) at least twice per week for at least 2 weeks.

In some embodiments, the method of treatment can be divided into twostages. The “starter” stage encompasses daily administration of thepharmaceutical composition. In some embodiments, the starter stageencompasses administration of the pharmaceutical composition at leastonce daily for 7 consecutive days. In some embodiments, the starterstage encompasses administration of the composition of the presentinvention daily for at least 2 to 13 consecutive days. In someembodiments, the starter stage encompasses administration of thecomposition of the present invention daily for at least 5 to 13consecutive days. In some embodiments, the composition is administeredat least once daily for at least 7 consecutive days. In someembodiments, treatment of a female by administering a starter stage ispreferable for a female who has not recently been treated for amenopausal condition using any other hormone therapy. In someembodiments, treatment of a female by administering a starter stage ispreferable for a female who has previously been on hormone therapy, buthas stopped taking the therapy for such a time as to allow the vaginalcytology of the female to revert to a substantially post-menopausalstate. In some embodiments, treatment of a female by administering astarter stage is preferable for a female whose vaginal epithelialcytology is in a menopausal state.

The “maintenance” stage encompasses administration of the pharmaceuticalcomposition at least twice per week for at least two weeks. In someembodiments, the maintenance stage follows the starter stage. In someembodiments, the maintenance stage comprises administering thecomposition of the present invention for two weeks. However, in someembodiments, the maintenance stage can be longer in duration. Forexample, the maintenance stage can continue until the menopausalcondition being treated no longer requires treatment. In someembodiments, the maintenance stage continues for 2 weeks to 2 years. Insome embodiments, the maintenance stage continues for 2 weeks to 1 year.In some embodiments, the maintenance continues for 3 weeks to 4 weeks.In some embodiments, the maintenance stage continues for 3.5 weeks. Insome embodiments, treatment of a female by administering the maintenancestage without a starter stage is preferable for a female who hasrecently been treated for a menopausal condition using hormone therapy.In some embodiments, treatment of a female by administering themaintenance stage without a starter stage is preferable for a femalewhose vaginal epithelial cytology is in a premenopausal state.

The term “once daily” refers to administration of a composition of thepresent invention once during a 24 hour period. In some embodiments, thecomposition is administered once per day. In some embodiments, thecomposition is administered twice per day. In some embodiments, thecomposition is administered more than twice per day.

The present invention is suitable for treatment of various menopausalconditions. The term “menopausal condition” relates to conditionsassociated with menopause, or to the period of natural cessation ofmenstruation. Additionally, the term “menopausal condition” also relatesto conditions related to peri-menopause, post menopause, oroophorectomized women. Thus, the term menopausal condition is notlimited to females that are undergoing menopause, but also women who areundergoing peri-menopause or post-menopause, women who have beenbilaterally oophorectomized, or women whose endogenous sex hormoneproduction has been suppressed by pharmaceutical chemical compositions,e.g., GnRH agonists such as leuprolide-acetate sold under the tradenameLUPRONE® (TAP Pharmaceutical Products, Inc) or goserilin acetate, soldunder the tradename ZOLADEX® (AstraZeneca). The phrase “vaginalepithelial cytology is in a premenopausal state” refers to the state ofa vaginal epithelial of a woman who has not yet entered perimenopause ormenopause. The phrase “vaginal epithelial cytology is in a menopausalstate” refers to the state of a vaginal epithelial of a woman who is inmenopause and is not taking any form of hormone replacement therapy. Thestate of the vaginal epithelial can be evaluated as described by Mandelet al (J. Clin. Endocrinol. Metabol. 57: 133-139 (1983)).

Various menopausal conditions can exist. In some embodiments, amenopausal condition can be, but is not limited to, vaginal dryness,pain during intercourse (dyspareunia), increased risk of infections,inability to control urination (incontinence), increased frequency ofurinary infections, vaginal atrophy, kraurosis vulvae, hot flashes andnight sweats, fatigue, emotional changes (mood swings and changes insexual interest), sleep disturbances (insomnia), drier skin and hair,increased growth of facial and body hair, aches and pains in the joints,headaches, palpitations (rapid, irregular heart beats), vaginal itching,osteoporosis, osteopenia, and generalized itching.

In some embodiments, the pharmaceutical composition can be administeredvaginally by contacting the pharmaceutical composition with the vaginaltract of the female being treated. In some embodiments, thepharmaceutical composition can be administered orally by contacting thepharmaceutical composition with the oral cavity of the female beingtreated. In some embodiments, once the pharmaceutical composition isadministered, the estrogens act locally (for example, on the vaginal ororal epithelia, i.e., non-systemically). In some embodiments, once thepharmaceutical composition is administered, the estrogens actsystemically on the female being treated. Thus, in some embodiments,administration of the pharmaceutical composition of the presentinvention provides systemic treatment of a menopausal condition. In someembodiments, administration of the pharmaceutical composition of thepresent invention provides both systemic and local treatment of amenopausal condition.

In some embodiments, administration of the composition of the presentinvention can produce a pulsatile pharmacokinetic delivery profile ofestrogens. In these embodiments, after administration of the compositionof the present invention, an initial increase in the plasmaconcentration of estrogens occurs. Blood plasma concentration levels ofestrogens then peak, after which there is a decrease in the plasmaconcentration of estrogens in the female being treated. Uponadministration of another dose of the composition, the plasmaconcentration of estrogen again increases, peaks, and then decreases.The term “pulsatile pharmacokinetic profile” refers to the cyclicincrease, peak, and decrease of plasma concentrations of estrogens. Insome embodiments, the pulsatile pharmacokinetic profile is reduced uponrepeated administration of the composition of the present invention.That is, the peak plasma concentration of estrogens is less than thepeak plasma concentration of estrogens achieved by the previousadministration of the composition of the present invention. In someembodiments, after repeated administration of the estrogens, anessentially steady state pharmacokinetic profile is reached, resultingin a relatively constant pulsatile pharmacokinetic profile. That is, thepeak at steady state following administration of the composition of thepresent invention remains relatively constant upon administration ofadditional doses of the composition of the present invention. In someembodiments, after two weeks, the pulsatile delivery of estrogens is atsteady state. In some embodiments, after four weeks, the pulsatiledelivery of estrogens is at steady state.

Kits, Dosage Forms, and Applicators

In some embodiments, the present invention is also directed to a kit oran applicator comprising a monophasic pharmaceutical compositioncomprising a conjugated estrogen and a hydrophilic or lipophilicexcipient.

In some embodiments, the present invention is directed to a kitcomprising a dosage form comprising the pharmaceutical compositions ofthe present invention. As used herein, the term “dosage form” refers toa dosage of a composition of the present invention which is administeredto a patient in about a 24 hour period. In some embodiments, multipledosage forms can be contained in one kit. In some embodiments, one ormore dosage forms are separately packaged from other dosage forms, e.g.,individual dosage forms. In some embodiments, the dosage form is acapsule containing a pharmaceutical composition described herein. Insome embodiments, the dosage form comprises a membrane or envelope thatsurrounds the pharmaceutical composition. In some embodiments, thedosage form is a vaginal sachet containing the pharmaceuticalcomposition. In some embodiments, the dosage form comprises an amount ofa pharmaceutical composition as described herein contained in anapplicator. In some embodiments, the dosage form comprises an amount ofa pharmaceutical composition as described herein contained in a vaginalapplicator. In some embodiments, the dosage form comprises an amount ofa pharmaceutical composition as described herein contained in an oralapplicator. In some embodiments, the oral applicator comprises an amountof a pharmaceutical composition as described herein as a spray. In someembodiments, the applicator is used to administer a single unit-dose ofa pharmaceutical composition as described herein.

Various numbers of dosage forms can be contained in a single kit. Insome embodiments, the kit can comprise from 1 to about 60 or 1 to about30 dosage forms comprising the pharmaceutical compositions as describedherein. In some embodiments, the kit comprises at least 2 dosage formscomprising the pharmaceutical compositions as described herein. In someembodiments, the kit comprises at least 7 dosage forms comprising thepharmaceutical compositions as described herein. For example, the kitcan comprise dosage forms sufficient for initial therapy (e.g., one doseper day for 7 days). In some embodiments, the kit comprises at least 13dosage forms comprising a composition of the present invention. In someembodiments, the kit can comprise 13 to 14 dosage forms comprising thepharmaceutical compositions as described herein. For example, the kitcan comprise dosage forms sufficient for initial therapy plus theremainder of the month (e.g., one dose per day for 7 days plus one doseper day, 2 days per week for the remainder of the month (6-7 doses)). Insome embodiments, the kit can comprise at least 8 dosage formscomprising the pharmaceutical compositions as described herein. In someembodiments, the kit can comprise 8 to 9 dosage forms comprising thepharmaceutical compositions as described herein. For example, the kitcan comprise dosage forms sufficient for administration 2 days per weekfor a month. One of skill in the art could produce additional kits whichprovide a suitable number of dosage forms within the scope of theinvention. For example, a kit comprising dosage forms sufficient for twoto six months.

In some embodiments, the present invention is directed to a kitcomprising vaginal or oral applicators, wherein each of the vaginal ororal applicators comprises a pharmaceutical composition of the presentinvention. In some embodiments, the vaginal or oral applicators aredisposable. The term “disposable” refers to applicators that areintended to be used once, and then discarded. In some embodiments, theapplicators are used once to administer a single-unit dose, and thendiscarded. In some embodiments, release of a dose requires a subject toapply pressure to the applicator, for example, by squeezing, pressing,pushing, or otherwise directly manipulating the applicator to cause therelease of a single-unit dose of the monophasic pharmaceuticalcomposition. The disposable applicators can come in any shape and sizesuitable for applying the pharmaceutical composition of the presentinvention into a vaginal tract or oral cavity. For example, in someembodiments, the applicator is a syringe. In some embodiments, theapplicator is a squeezable tube shaped to allow administration of thepharmaceutical composition directly to the vaginal tract. In someembodiments, the applicator comprises a spray, solution, suspension, orother composition of the present invention for delivery to the oralcavity. Alternatively, the kit can comprise a single containercomprising multiple doses of the composition. For example, the kit canbe a container containing a month's supply of the pharmaceuticalcomposition. In some embodiments, the kit can comprise one or moreapplicators to apply the pharmaceutical composition from the containercomprising multiple doses. In some embodiments, the kit can comprise oneor more devices used to measure an appropriate amount of the compositionof the present invention.

The applicator can comprise various amounts of conjugated estrogens. Insome embodiments, each applicator comprises a single dosage form of thecomposition. For example, in some embodiments, the applicator comprisesa conjugated estrogen equivalent to about 50 μg to about 5 mg of sodiumestrone sulfate. In some embodiments, the applicator comprises aconjugated estrogen equivalent to about 30 μg to about 3 mg of sodiumequilin sulfate. In some embodiments, the applicator comprises aconjugated estrogen equivalent to about 1 μg to about 100 μg of sodium17β-estradiol sulfate.

The kits of the present invention can contain various amounts of vaginalor oral applicators. In some embodiments, the applicators aredisposable. In some embodiments, the kit comprises 1 to about 30disposable applicators. In some embodiments, the kit comprises about 5to about 20 applicators. In some embodiments, the kit comprises at least2 applicators. In some embodiments, the kit comprises at least 7applicators. In some embodiments, the kit comprises at least 8applicators. In some embodiments, the kit comprises 8 to 9 applicators.In some embodiments, the kit comprises at least 13 applicators. In someembodiments, the kit comprises 13 to 14 applicators. In someembodiments, the applicators in a kit comprise one or more of theingredients of a pharmaceutical composition as described herein.

The kit can include one or more containers filled with one or more ofthe ingredients of a pharmaceutical composition of the invention. Insome embodiments, a pharmaceutical composition of the present inventionis stored in a container essentially impermeable to oxygen. In someembodiments, the composition is purged with an inert gas, e.g., nitrogengas.

Optionally associated with such container(s) can be a notice or printedinstructions. For example, such printed instructions can be in a formprescribed by a governmental agency regulating the manufacture, use, orsale of pharmaceuticals or biological products, which notice reflectsapproval by the agency of the manufacture, use, or sale for humanadministration to treat a menopausal condition. In some embodiments, thekit further comprises printed matter, which, e.g., provides informationon the use of the composition to treat a menopausal condition, apre-recorded media device which, e.g., provides information on the useof the applicator or pharmaceutical composition to treat a menopausalcondition, or a planner.

“Printed matter” can be, for example, one of a book, booklet, brochure,or leaflet. The printed matter can describe the use of the applicator orpharmaceutical composition of the present invention for the treatment ofa menopausal condition. Possible formats include, but are not limitedto, a bullet point list, a list of frequently asked questions (FAQ), ora chart. Additionally, the information to be imparted can be illustratedin non-textual terms using pictures, graphics, or other symbols.

“Pre-recorded media device” can be, for example, a visual media device,such as a videotape cassette, a DVD (digital video disk), filmstrip, 35mm movie, or any other visual media device. Alternately, pre-recordedmedia device can be an interactive software application, such as aCD-ROM (compact disk-read only memory) or floppy disk. Alternately,pre-recorded media device can be, for example, an audio media device,such as a record, audiocassette, or audio compact disk. The informationcontained on the pre-recorded media device can describe the use of theapplicator or pharmaceutical composition of the present invention forthe treatment of a menopausal condition.

A “planner” can be, for example, a weekly, a monthly, a multi-monthly, ayearly, or a multi-yearly planner. The planner can be used as a diary tomonitor dosage amounts, to keep track of dosages administered, or toprepare for future events wherein taking a regularly administeredpharmaceutical composition of the present invention may be difficult.Alternately, the planner can be a calendar which will provide a means tomonitor when a dosage has been taken and when it has not been taken.This type of planner will be particularly useful for patients havingunusual schedules for administering medication to themselves.Additionally, the planner can be useful for the elderly, or otherpatient group who may administer medication to themselves and may becomeforgetful. One skilled in the art will appreciate the variety ofplanning tools that would be appropriate for use with the presentinvention.

The kit can also include a container for storing the other components ofthe kit. The container can be, for example, a bag, box, envelope, or anyother container that would be suitable for use in the present invention.Preferably, the container is large enough to accommodate each componentand/or any applicators that may be necessary for a pharmaceuticalcomposition of the present invention. However, in some cases, it may bedesirable to have a smaller container which can be hidden in a patient'spocketbook, briefcase, or pocket.

The present invention is also directed to a method of delivery of theapplicators or pharmaceutical compositions of the present invention to afemale in need thereof, the method comprising (a) registering in acomputer readable medium the identity of a physician permitted toprescribe the applicator or composition; (b) providing the female withcounseling information concerning the risks attendant to the applicatoror composition; (c) obtaining informed consent from the female toreceive the applicator or composition despite the attendant risks; (d)registering the female in a computer readable medium after obtainingtheir informed consent; and (e) permitting the female access to theapplicator or composition.

The drug delivery methods of the present invention involve, inter alia,registering in a computer readable storage medium physicians who arequalified to prescribe the applicators or pharmaceutical compositions ofthe present invention. Once registered in the computer readable storagemedium, the physician can be eligible to prescribe the applicators orpharmaceutical compositions to a female in need thereof. Generallyspeaking, in order to become registered in the computer readable storagemedium, the physician may be required to comply with various aspects of,for example, providing patient education and counseling. Theregistration of the physician in the computer readable storage mediumcan be achieved by providing the physician, for example, by mail,facsimile transmission, or on-line transmission, with a registrationcard or form, preferably together with educational materials concerningthe applicators or pharmaceutical compositions of the present invention.The physician can complete the registration card or form by providinginformation requested therein, and the registration card or form can bereturned to the manufacturer or distributor of the applicators orpharmaceutical compositions of the present invention, or otherauthorized recipient of the registration materials, for example, bymail, facsimile transmission or on-line transmission. The physician'sinformation in the registration card or form is then entered into thecomputer readable storage medium. Suitable computer readable storagemedia which can be employed for registration of the physicians (as wellas patients, as discussed below) will be apparent to one of ordinaryskill in the art, once in possession of the teaching of the presentapplication.

In the course of examination of a patient, including a patient sufferingfrom a menopausal condition, the physician may determine that thepatient's condition can be improved by the administration of theapplicators or pharmaceutical compositions of the present invention.Prior to prescribing the applicators or pharmaceutical compositions ofthe present invention, the physician can counsel the patient, forexample, on the various risks and benefits associated with theapplicators or pharmaceutical compositions. The patient can be providedfull disclosure of all the known and suspected risks associated with theapplicator or pharmaceutical composition. Such counseling can beprovided verbally, as well as in written form. In some embodiments, thephysician can provide the patient with literature materials on theapplicator or pharmaceutical composition, such as product information,educational materials, and the like.

In addition to receiving counseling on the risks attendant to theapplicators or pharmaceutical compositions of the present invention, themethods of the invention further require the patient to fill out aninformed consent form which is signed by the patient. Upon thecompletion of the informed consent form, the patient can be registeredin a computer readable storage medium. The computer readable storagemedium in which the patient is registered can be the same as, ordifferent from, the computer readable storage medium in which thephysician is registered.

The registration into one or more computer readable storage media of thephysician and patient, according to the methods describe herein,provides a means to monitor and authorize access to the applicators orpharmaceutical compositions of the present invention. Thus, the computerreadable storage medium can serve to deny access to patients who fail toabide by the methods of the present invention. In some embodiments,access to the applicators or pharmaceutical compositions of theinvention is in the form of a prescription, wherein the prescribingphysician is registered in a computer readable storage medium, hasprovided counseling to the patient concerning the attendant risks of theapplicators or pharmaceutical compositions, and has obtained informedconsent from the patient, prior to prescribing the applicators orpharmaceutical compositions to the patient in need thereof.

The present invention is also directed to methods of educating consumersabout the use of an applicator or pharmaceutical composition of theinvention, the method comprising distributing the applicator orpharmaceutical composition with consumer information at a point of sale.In some embodiments, the distribution will occur at a point of salehaving a pharmacist or healthcare provider.

As used herein, the term “consumer information” can include, but is notlimited to, an English language text, non-English language text, visualimage, chart, telephone recording, website, and access to a livecustomer service representative. In some embodiments of the presentinvention, consumer information will provide directions for use of theapplicator or pharmaceutical composition of the present invention,appropriate age use, indication, contraindications, appropriate dosing,warnings, telephone number of website address. In some embodiments, themethod further comprises providing professional information to relevantpersons in a position to answer consumer questions regarding theapplicator or pharmaceutical composition.

As used herein, the term “professional information” includes, but is notlimited to, information concerning the applicator or pharmaceuticalcomposition of the present invention designed to enable a healthcareprofessional to answer customer questions regarding the applicator orpharmaceutical composition.

A “relevant person,” as used herein, includes, for example, a physician,physician assistant, nurse practitioner, pharmacist, and customerservice representative.

All of the various embodiments or options described herein can becombined in any and all variations.

The following examples are further illustrative of the presentinvention, but are not to be construed to limit the scope of the presentinvention.

EXAMPLE 1

Aqueous-based, glycerin-based, and lipid-based monophasic pharmaceuticalformulations were prepared as described in Table 3. The conjugatedestrogens present in the formulations described in Table 3 contain amixture of 9 synthetic conjugated estrogens (Diosynth, Inc., Chicago,Ill.), consisting of sodium estrone sulfate, sodium equilin sulfate,sodium 17α-dihydroequilin sulfate, sodium 17β-dihydroequilin sulfate,sodium 17α-estradiol sulfate, sodium 17β-estradiol sulfate, sodiumequilenin sulfate, sodium 17α-dihydroequilenin sulfate, and sodium17β-dihydroequilenin sulfate.

TABLE 3 Formulation Compositions for Conjugated Estrogens 1.25 mg/500 mgmg/500 mg Aqueous-based Glycerin-based # Ingredients HPMC Carbopol ®Carbopol ® 1 Conjugated Estrogens DE (565 mg/g) 2.251* 2.212 2.2122.251* 2.212 2 Carbomer 934P, NF (Carbopol ®) — 2 3.75 5 — 3 Carbomer974P, NF (Carbopol ®) — — — — 3.75 4 Hypromellose 2208, USP (Methocel ®K15M PR) 15 — — — — 5 Methyl Paraben, NF 0.4 0.4 0.4 0.4 0.4 6 PropylParaben, NF 0.1 0.1 0.1 0.1 0.1 7 Benzyl Alcohol, NF — — — — — 8 t-ButylHydroquinone 0.1 0.1 0.1 0.1 0.1 9 Butylated Hydroxytoluene (Food Grade,Tenox BHT) 0.25 — — — — 10 Butylated Hydroxyanisole (Food Grade, TenoxBHA) 0.625 — — — — 11 Vitamin E, USP (dl-alpha Tocopheryl Acetate) 0.25— — — — 12 Edetate Disodium Dihydrate, USP 0.25 0.25 0.25 0.25 0.25 13Polysorbate 80, NF 0.5 0.5 0.5 0.5 0.5 14 Dehydrated Alcohol, USP (EthylAlcohol 200 proof) 25 25 25 25 25 15 Sodium Hydroxide, NF — 0.675 1.171.62 1.125 16 Purified Water, USP 405.3 417 405.3 432.5 5.1 17 Glycerin(Anhydrous) 50 50 61.2 32.3 461.5 18 Gelucire ® 44/14 — — — — — 19Peanut Oil, NF (Refined) — — — — — 20 Dibasic Sodium Phosphate — 0.75 —— — 21 Hydrochloric Acid (5N) to adjust the pH — 3.5 — — — Total Weight(mg) 500 502.5 500 500 500 Viscosity 817 8.3 700 1760 1700 StabilityData, % Label Claim (Initial) Sum of Estrone + Equilin +17α-Dihydroequilin 95.9 88.6 87.4 101.3 96.6 Ratio of Equilin/Estrone0.44 0.43 0.43 0.43 0.43 17α-Dihydroequilenin DBNQ 0.1 ND ND NDEquilenin 0.3 0.5 0.4 0.4 0.3 Stability Data, % Label Claim (60° C./1week) Sum of Estrone + Equilin + 17α-Dihydroequilin 97.3 88.0 102.4 99.795.1 Ratio of Equilin/Estrone 0.43 0.43 0.42 0.43 0.4317α-Dihydroequilenin 1.1 0.4 0.9 0.3 0.4 Equilenin 0.4 0.5 0.5 0.4 0.4mg/500 mg Glycerin-based Lipid-based # Ingredients Carbopol ® GlycerinGelucire ® 1 Conjugated Estrogens DE (565 mg/g) 2.251* 2.251* 2.251* 2Carbomer 934P, NF (Carbopol ®) — — — 3 Carbomer 974P, NF (Carbopol ®)3.75 — — 4 Hypromellose 2208, USP (Methocel ® K15M PR) — — — 5 MethylParaben, NF 0.4 0.4 0.4 6 Propyl Paraben, NF 0.1 0.1 0.1 7 BenzylAlcohol, NF — — 5 8 t-Butyl Hydroquinone — 0.1 — 9 ButylatedHydroxytoluene (Food Grade, Tenox BHT) 0.25 0.25 0.25 10 ButylatedHydroxyanisole (Food Grade, Tenox BHA) 0.625 0.625 0.625 11 Vitamin E,USP (dl-alpha Tocopheryl Acetate) 0.25 0.25 0.25 12 Edetate DisodiumDihydrate, USP 0.25 0.25 0.25 13 Polysorbate 80, NF 0.5 0.5 0.5 14Dehydrated Alcohol, USP (Ethyl Alcohol 200 proof) 25 25 25 15 SodiumHydroxide, NF 0.9 — — 16 Purified Water, USP 4.1 — — 17 Glycerin(Anhydrous) 461.6 470.3 27.9 18 Gelucire ® 44/14 — — 425 19 Peanut Oil,NF (Refined) — — 12.5 20 Dibasic Sodium Phosphate — — — 21 HydrochloricAcid (5N) to adjust the pH — — — Total Weight (mg) 500 500 500 Viscosity1011 6.0 22,200 Stability Data, % Label Claim (Initial) Sum of Estrone +Equilin + 17α-Dihydroequilin 107.0 98.5 94.1 Ratio of Equilin/Estrone0.44 0.43 0.43 17α-Dihydroequilenin DBNQ ND DBNQ Equilenin 0.4 0.3 0.2Stability Data, % Label Claim (60° C./1 week) Sum of Estrone + Equilin +17α-Dihydroequilin 106.5 93.8 85.8 Ratio of Equilin/Estrone 0.43 0.430.43 17α-Dihydroequilenin 0.1 0.3 0.2 Equilenin 0.4 0.3 0.5 *Calculationbased upon 98.3% assay. Theoretical amount = 2.212 mg. DBNQ: Detectedbut not quantitated. ND: Not Detected.

EXAMPLE 2

Pharmaceutical semi-solid, monophasic formulations of conjugatedestrogens were prepared as described in Table 4. Two preparations ofconjugated estrogens were used: (a) Conjugated Estrogens, USP (Type DE565 mg/g), a combination of nine synthetic conjugated estrogens(Diosynth, Inc., Chicago, Ill.) consisting of sodium estrone sulfate,sodium equilin sulfate, sodium 17α-dihydroequilin sulfate, sodium17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, and sodium 17β-dihydroequilenin sulfate;and (b) Conjugated Estrogens (37.5 mg/g) a combination of 10 syntheticconjugated estrogens (Organics/LaGrange, Chicago, Ill.) consisting ofsodium estrone sulfate, sodium equilin sulfate, sodium17α-dihydroequilin sulfate, sodium 17β-dihydroequilin sulfate, sodium17α-estradiol sulfate, sodium 17β-estradiol sulfate, sodium equileninsulfate, sodium 17α-dihydroequilenin sulfate, sodium17β-dihydroequilenin sulfate, and sodium Δ8,9-dehydroestrone sulfate.

The Gelucire®-based formulation prepared with Conjugated Estrogens, USP(Type DE 565 mg/g) contained 85% Gelucire®, while the Gelucire®-basedformulation prepared with Conjugated Estrogens (37.5 mg/g) contained 50%Gelucire®. Additionally, differing viscosities between the formulationsproduced from Conjugated Estrogens (37.5 mg/g) and Conjugated Estrogens(37.5 mg/g) were also attributable to differences in inactiveingredients present in the conjugated estrogens supplied by themanufacturers.

TABLE 4 Conjugated Estrogens Semi-Solid Formulations (1.25 mg/500 mg)Aqueous-based Glycerin-based Gelucire ®-based Conjugated ConjugatedConjugated Estrogens, USP Conjugated Estrogens, Conjugated Estrogens,Conjugated (Type DE Estrogens USP (Type DE Estrogens USP (Type DEEstrogens # Ingredients 565 mg/g) (37.5 mg/g) 565 mg/g) (37.5 mg/g) 565mg/g) (37.5 mg/g) 1 Carbomer 934P, NF X X — — — — (Carbopol ®) 2Carbomer 974P, NF — — X X — — (Carbopol ®) 3 Gelucire ® 44/14 — — — — XX 4 Preservatives X X X X X X 5 Stabilizers X X X X X X 6 PermeationEnhancer X X X X X X 7 Alkalizing Agent X X X X — — 8 Ethanol X X X X XX 9 Purified Water, X X X X X X USP/Glycerin Total Weight (mg) 500 500500 500 500 500 Viscosity (Poise) 1760 248 1011 93 22,200 94

EXAMPLE 3

Stability studies of the formulations in Table 4 were performed. Eachformulation was manufactured at a batch size of 1 kg using a laboratorymixer. The final product was packaged into 75-cc amber glass bottles,heat sealed, and stored at 60° C. for stability studies.

The results of the chemical stability studies as evaluated by HPLCanalysis of component estrogens are shown in FIGS. 1-4. The resultsindicate that the ratio of equilin to estrone was substantially constantfor all the formulations after 3-4 weeks at 60° C. (FIG. 1 and FIG. 3).Levels of equilenin were also measured as an indicator of degradationafter 3-4 weeks at 60° C. After 3-4 weeks at 60° C., levels of equileninwere ≦0.7% in formulations prepared with Conjugated Estrogens USP (TypeDE, 565 mg/g) (FIG. 2B), and ≦1.62% in formulations prepared withConjugated Estrogens (37.5 mg/g) (FIG. 4B).

The pH of formulations prepared with Conjugated Estrogens USP (Type DE,565 mg/g) was maintained after 3-4 weeks at 60° C. Formulations preparedwith Conjugated Estrogens (37.5 mg/g) showed a slight increase in pH inthe range of about 0.1 to 0.7 units after 3-4 weeks at 60° C., butremained within a pH range of 6.0 to 8.5.

EXAMPLE 4

For the aqueous-based and glycerin-based formulations prepared fromConjugated Estrogens (37.5 mg/g), preliminary in vitro diffusion studieswere performed measuring the diffusion of estrone (FIG. 5A) or equilin(FIG. 5B) against cellulose acetate membrane (25 mm diameter, 0.45 μmpore size) kept between the donor and receiver compartments of aHanson's Franz Cell apparatus. The results demonstrate comparablediffusion from the aqueous-based and glycerin-based formulations.

Preliminary in vitro diffusion studies were also performed measuring thediffusion of estrone against normal human vaginal ectocervical tissue(FIGS. 6-8) to evaluate the diffusion from semi-solid, monophasicconjugated estrogens formulations in comparison with diffusion fromPremarin® cream. The results demonstrate that the diffusion from theglycerin-based formulation prepared from Conjugated Estrogens (37.5mg/g) was much higher than diffusion from Premarin® cream (FIG. 7).Diffusion from the aqueous-based and glycerin-based formulationsprepared from Conjugated Estrogens USP (Type DE, 565 mg/g) was muchhigher than diffusion from Premarin® cream (FIG. 8).

EXAMPLE 5

Spreadability studies were also performed for the formulations describedin Table 4. Spreadability studies were conducted by applying a 125 gweight load on 2 g of product placed between two petri plates. Theweight was placed on the petri plate over the product and the meandiameter of spreading was monitored over 1, 5, and 15 minutes. Basedupon the mean spread diameter, the spread area was calculated. See,e.g., De Paula et al., Drug Dev Ind Pharm 24(3): 235-241 (1998). Theresults for spreadability are indicated in Table 5 for spread area at 15minutes after the 125 g load was applied.

As indicated in Table 5, all of the semi-solid, monophasic formulationsdisplayed better spreadability as compared with Premarin® cream, andEstrace® cream, except for the Gelucire®-based formulation prepared fromConjugated Estrogens, USP (Type DE, 565 mg/g) containing 85% Gelucire®.

TABLE 5 Spreadability Data % Spread as compared to estimated Spreadhuman vaginal Area surface area Product (cm²) (87.5 cm²)* Water 78.289.4 Glycerin 70.2 80.2 Premarin ® cream 57.8 66.1 Estrace ® cream 48.955.9 Aqueous-based Conjugated Estrogens, 70.3 80.3 USP (Type DE, 565mg/g) Glycerin-based Conjugated Estrogens, 60.2 68.8 USP (Type DE, 565mg/g) Gelucire ® Conjugated Estrogens, 27.5 31.4 USP (Type DE, 565 mg/g)Aqueous-based Conjugated Estrogens 69.3 79.2 (37.5 mg/g) Glycerin-basedConjugated Estrogens 78.8 90.1 (37.5 mg/g) Gelucire ® ConjugatedEstrogens 84.2 96.2 (37.5 mg/g) *Pendergrass, P. B. et al., Gynecol ObstInvest 55(2): 110-113 (2003).

EXAMPLE 6

Aqueous-based, glycerin-based, and Gelucire®-based monophasic,semi-solid pharmaceutical formulations of conjugated estrogens wereprepared as described in Table 6 and as described in FIG. 9. Thesynthetic conjugated estrogens in Table 6 contain a mixture of 9estrogens (Diosynth, Inc., Chicago, Ill.): sodium estrone sulfate,sodium equilin sulfate, sodium 17α-dihydroequilin sulfate, sodium17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, and sodium 17β-dihydroequilenin sulfate.In contrast to the formulations described in Table 4, the formulationsdescribed in Table 6 do not contain ethanol.

Additional formulations containing sodium Δ8,9-dehydroestrone sulfatewill be prepared.

TABLE 6 Formulation Compositions for Conjugated Estrogens (1.25 mg/500mg) Aqueous- Glycerin- Gelucire ®- based based based # Ingredientsmg/500 mg mg/500 mg mg/500 mg 1 Conjugated Estrogens, 2.250* 2.250*2.250* USP (Type DE 565 mg/g) 2 Carbomer 934P, NF 5 — — (Carbopol ®) 3Carbomer 974P, NF — 3.75 — (Carbopol ®) 4 Gelucire ® 44/14 — — 225 5Methyl Paraben, NF 0.4 0.4 0.4 6 Propyl Paraben, NF 0.1 0.1 0.1 7 BenzylAlcohol, NF 2.5 2.5 — 8 Butylated Hydroxy- 0.25 0.25 0.25 toluene (FoodGrade, Tenox BHT) 9 Butylated Hydroxy- 0.625 0.625 0.625 anisole (FoodGrade, Tenox BHA) 10 Vitamin E, USP (dl- 0.25 0.25 0.25 alpha TocopherylAcetate) 11 Edetate Disodium 0.25 0.25 0.25 Dihydrate, USP 12Polysorbate 80, NF 0.5 0.5 0.5 13 Propyleneglycol, USP 15 15 — 14 SodiumHydroxide, NF 1.9 1.0 — 15 Purified Water, USP 408.6 4.8 245.4 16Glycerin, USP 62.35 — 25 17 Glycerin (Anhydrous) — 468.35 — Total Weight500 mg 500 mg 500 mg pH 6.85 7.75 7.84 Viscosity (poise) 1529 603 1643*Calculation based upon 98.3% assay. Theoretical amount = 2.212 mg

EXAMPLE 7

Stability studies of the formulations in Table 6 were performed.Formulations were packaged into 75-cc amber glass bottles, heat sealed,and stored at 60° C. for 4 weeks or were stored at 40° C. and 75%relative humidity for 1 month. The results are shown in Table 7.

TABLE 7 Stability Data of Conjugated Estrogens Gel Formulations at 60°C. for 4 weeks and at 40° C./75% RH for 1 Month Aqueous-based 40 C./Gelucire ®-Based 60 C. 60 C. 60 C. 60 C. 75% RH 60 C. 60 C. AnalyteInitial 1 wk 2 wks 3 wks 4 wks 1 Month Initial 1 wk 2 wks Estrone (Es)61.4 62.0 62.5 62.4 62.5 62.0 59.4 60.7 61.1 Equilin (Eq) 28.0 26.6 26.126.9 26.4 27.1 27.1 26.3 25.9 17α-DHQ 18.5 17.6 17.1 17.8 17.1 18.0 18.017.7 17.4 Sum of three 107.9 106.2 105.7 107.1 106.0 107.1 104.5 104.7104.4 Ratio of Eq/Es 0.46 0.43 0.42 0.43 0.42 0.44 0.46 0.43 0.4217α-DHQN ND 0.6 1.1 0.7 1.6 0.3 ND 0.3 0.6 Equilenin 0.5 1.0 1.4 1.0 1.90.8 0.3 0.8 1.1 Gelucire ®-Based Glycerin-based 40 C./ 40 C./ 60 C. 60C. 75% RH 60 C. 60 C. 60 C. 60 C. 75% RH Analyte 3 wks 4 wks 1 MonthInitial 1 wk 2 wks 3 wks 4 wks 1 Month Estrone (Es) 59.4 61.1 60.7 57.257.9 55.0 59.2 55.0 57.9 Equilin (Eq) 25.0 26.1 27.1 26.1 25.6 24.1 25.926.9 26.6 17α-DHQ 16.7 17.3 18.2 17.3 17.2 16.2 17.4 18.0 17.9 Sum ofthree 101.1 104.5 106.0 100.6 100.7 95.3 102.5 99.9 102.4 Ratio of Eq/Es0.42 0.43 0.45 0.46 0.44 0.44 0.44 0.49 0.46 17α-DHQN 0.7 1.0 0.6 ND ND0.2 0.3 0.3 ND Equilenin 1.1 1.5 0.5 0.4 0.4 0.6 0.6 0.8 0.4 17α-DHQ:17-αDihydroequilin; 17α-DHQN: 17-αDihydroequilenin.

The results indicate that the ratio of equilin to estrone wassubstantially constant for all the formulations after 4 weeks at 60° C.or after 1 month at 40° C. and 75% relative humidity. Levels ofequilenin were also measured as an indicator of degradation after 4weeks at 60° C. or after 1 month at 40° C. and 75% relative humidity.After 4 weeks at 60° C., the levels or equilenin were at 1.9%, 1.5%, or0.8% for the aqueous-based, Gelucire®-based, and glycerin-basedformulations shown in Table 7. The levels of equilenin were alsosubstantially similar after 1 month at 40° C. and 75% relative humidity,varying by 0.3%, 0.2%, and 0% for the aqueous-based, Gelucire®-based,and glycerin-based formulations, respectively, as shown in Table 7.

EXAMPLE 8

In vitro diffusion studies were also performed measuring the diffusionof estrone against normal human vaginal ectocervical tissue (FIG. 10) toevaluate the diffusion from the semi-solid, monophasic conjugatedestrogens formulations described in Table 6 in comparison with diffusionfrom Premarin® cream. The results demonstrate that diffusion of estronefrom the aqueous-based and glycerin-based formulations was much higherthan diffusion of estrone from Premarin® cream (FIG. 10).

EXAMPLE 9

Spreadability studies were also performed for the formulations describedin Table 6 with results as indicated in Table 8.

As indicated in Table 8, all of the semi-solid, monophasic formulationsdisplayed better spreadability as compared with Premarin® cream, andEstrace® cream.

TABLE 8 Spreadability Data % Spread as compared to estimated Spreadhuman vaginal Area surface area Product (cm²) (87.5 cm²)* Water 78.289.4 Glycerin 70.2 80.2 Premarin ® cream 57.8 66.1 Estrace ® cream 48.955.9 Aqueous-based Conjugated Estrogens, 67.2 76.8 USP (Type DE, 565mg/g) Glycerin-based Conjugated Estrogens, 74.2 84.8 USP (Type DE, 565mg/g) Gelucire ® Conjugated Estrogens, 63.7 72.8 USP (Type DE, 565 mg/g)*Pendergrass, P. B. et al., Gynecol Obst Invest 55(2): 110-113 (2003).

These examples illustrate possible embodiments of the present invention.While the invention has been particularly shown and described withreference to some embodiments thereof, it will be understood by thoseskilled in the art that they have been presented by way of example only,and not limitation, and various changes in form and details can be madetherein without departing from the spirit and scope of the invention.Thus, the breadth and scope of the present invention should not belimited by any of the above-described exemplary embodiments, but shouldbe defined only in accordance with the following claims and theirequivalents.

All documents cited herein, including journal articles or abstracts,published or corresponding U.S. or foreign patent applications, issuedor foreign patents, or any other documents, are each entirelyincorporated by reference herein, including all data, tables, figures,and text presented in the cited documents.

1. An applicator comprising a single unit-dose of a monophasicpharmaceutical composition comprising a conjugated estrogen and ahydrophilic excipient, wherein the composition has a viscosity greaterthan about 1 Poise and less than about 30,000 Poise, wherein theconjugated estrogen comprises a combination of sodium estrone sulfate,sodium equilin sulfate, sodium 17α-dihydroequilin sulfate, sodium17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate, andsodium Δ8,9-dehydroestrone sulfate, and wherein the diffusion of estroneor equilin from the composition across human vaginal tissue is fromabout 30% to about 90% at 24 hours.
 2. The applicator of claim 1,wherein the conjugated estrogen consists of a combination of sodiumestrone sulfate, sodium equilin sulfate, sodium 17αa-dihydroequilinsulfate, sodium 17β-dihydroequilin sulfate, sodium 17αa-estradiolsulfate, sodium 17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate, andsodium Δ8,9-dehydroestrone sulfate.
 3. The applicator of claim 1,wherein the hydrophilic excipient is selected from the group consistingof water, glycerin, propylene glycol, polyethylene glycol, polyol,alcohol, and combinations thereof.
 4. The applicator of claim 1, whereinthe composition comprises a pharmaceutically acceptable excipientselected from the group consisting of an alkaline agent, a stabilizer,an adhesion agent, a solvent, a surfactant, a humectant, a bufferingagent, and combinations thereof.
 5. The applicator of claim 4, whereinthe alkaline agent is an inorganic base selected from the groupconsisting of hydroxides and oxides of alkali metals, alkaline earthmetals, and combinations thereof.
 6. The applicator of claim 4, whereinthe alkaline agent is an organic base comprising an amine.
 7. Theapplicator of claim 4, wherein the stabilizer is selected from the groupconsisting of methyl paraben, propyl paraben, t-butyl hydroquinone,butylated hydroxyanisole, butylated hydroxytoluene, ascorbic acid andits esters, vitamin E and its esters, sodium bisulfite, sodiummetabisulfite, 3-dehydroshikimic acid, tocopherols and their esters,alkyl gallates, chelating agents, EDTA, edetate disodium, citric acid,benzyl alcohol, and combinations thereof.
 8. The applicator of claim 4,wherein the adhesion agent is selected from the group consisting ofhydrogenated vegetable oil, polyethylene glycol, cetyl alcohol, cetylesters wax, microcrystalline wax, paraffin, ethyl alcohol, stearylalcohol, lauryl alcohol, myristyl alcohol, cetostearyl alcohol, whitewax, yellow wax, beeswax, candelilla wax, cotton wax, carnauba wax,bayberry wax, ice-bran wax, carbomer, hydroxypropylmethylcellulose,hypromellose, starch, methylcellulose, microcrystalline cellulose, andcombinations thereof.
 9. The applicator of claim 4, wherein the solventis selected from the group consisting of water, glycerin, dehydratedalcohol, glyceryl esters of fatty acids, lauryl macrogolglycerides,polyoxyethylene alkyl ethers, and combinations thereof.
 10. Theapplicator of claim 4, wherein the surfactant is selected from the groupconsisting of sodium lauryl sulfate, polysorbate 80, poloxamer, laurylmacrogolglycerides, polyoxyethylene alkyl ethers, and combinationsthereof.
 11. The applicator of claim 4, wherein the humectant isselected from the group consisting of polyethylene glycol, propyleneglycol, glycerin, polyol, polyol derivatives, and combinations thereof.12. The applicator of claim 4, wherein the buffering agent is selectedfrom the group consisting of Tris buffers, Tris EDTA, Tris acetate, Trisphosphate, Tris glycine, phosphate buffers, sodium phosphate, sodiumphosphate dibasic, potassium phosphate, bicarbonate buffers, acetatebuffers, ammonium buffers, citrate buffers, organic acid buffers,zwitterionic buffers, and derivatives and combinations thereof.
 13. Theapplicator of claim 1, wherein the composition is substantially free ofethanol.
 14. The applicator of claim 1, wherein the applicator is avaginal applicator.
 15. The applicator of claim 1, wherein thecomposition has a viscosity greater than about 50 Poise and less thanabout 2,500 Poise.
 16. The applicator of claim 1, wherein thecomposition has a viscosity greater than about 90 Poise and less thanabout 2,000 Poise.
 17. The applicator of claim 1, wherein the diffusionof estrone or equilin from the composition across human vaginal tissueis from about 40% to about 90% at 24 hours.
 18. A monophasicpharmaceutical composition comprising: a conjugated estrogen and ahydrophilic excipient, wherein the composition has a viscosity greaterthan about 1 Poise and less than about 30,000 Poise, wherein theconjugated estrogen comprises a combination of sodium estrone sulfate,sodium equilin sulfate, sodium 17α-dihydroequilin sulfate, sodium17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate, andsodium Δ8,9-dehydroestrone sulfate, and wherein the diffusion of estroneor equilin from the composition across human vaginal tissue is fromabout 30% to about 90% at 24 hours.
 19. A monophasic pharmaceuticalcomposition comprising: a conjugated estrogen and a hydrophilicexcipient, wherein the composition has a viscosity greater than about 50Poise and less than about 2,500 Poise, wherein the conjugated estrogencomprises a combination of sodium estrone sulfate, sodium equilinsulfate, sodium 17α-dihydroequilin sulfate, sodium 17β-dihydroequilinsulfate, sodium 17α-estradiol sulfate, sodium 17β-estradiol sulfate,sodium equilenin sulfate, sodium 17α-dihydroequilenin sulfate, sodium17β-dihydroequilenin sulfate, and sodium Δ8,9-dehydroestrone sulfate,and wherein the diffusion of estrone or equilin from the compositionacross human vaginal tissue is from about 40% to about 90% at 24 hours.20. A monophasic pharmaceutical composition comprising: a conjugatedestrogen and a hydrophilic excipient, wherein the composition has aviscosity greater than about 90 Poise and less than about 2,000 Poise,wherein the conjugated estrogen comprises a combination of sodiumestrone sulfate, sodium equilin sulfate, sodium 17α-dihydroequilinsulfate, sodium 17β-dihydroequilin sulfate, sodium 17α-estradiolsulfate, sodium 17β-estradiol sulfate, sodium equilenin sulfate, sodium17αa-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate, andsodium Δ8,9-dehydroestrone sulfate, and wherein the diffusion of estroneor equilin from the composition across human vaginal tissue is fromabout 50% to about 90% at 24 hours.
 21. A kit comprising one or moreapplicators, wherein each applicator comprises a single unit-dose of amonophasic pharmaceutical composition comprising a conjugated estrogenand a hydrophilic excipient, wherein the composition has a viscositygreater than about 1 Poise and less than about 30,000 Poise, wherein theconjugated estrogen comprises a combination of sodium estrone sulfate,sodium equilin sulfate, sodium 17α-dihydroequilin sulfate, sodium17β-dihydroequilin sulfate, sodium 17α-estradiol sulfate, sodium17β-estradiol sulfate, sodium equilenin sulfate, sodium17α-dihydroequilenin sulfate, sodium 17β-dihydroequilenin sulfate, andsodium Δ8,9-dehydroestrone sulfate, and wherein the diffusion of estroneor equilin from the composition across human vaginal tissue is fromabout 30% to about 90% at 24 hours.
 22. The kit of claim 21, wherein theapplicator is a vaginal applicator.
 23. The kit of claim 21, furthercomprising printed instructions for use of the kit.
 24. The applicatorof claim 1, wherein the sodium estrone sulfate, sodium equilin sulfate,sodium 17α-dihydroequilin sulfate, sodium 17β-dihydroequilin sulfate,sodium 17α-estradiol sulfate, sodium 17β-estradiol sulfate, sodiumequilenin sulfate, sodium 17α-dihydroequilenin sulfate, sodium17β-dihydroequilenin sulfate, and sodium Δ8,9-dehydroestrone sulfate aresynthetic conjugated estrogens.
 25. The applicator of claim 1, whereinthe single unit-dose is an amount of about 50 mg to about 7.5 g of thecomposition.
 26. The applicator of claim 1, wherein the single unit-doseis an amount of about 100 mg to about 1 g of the composition.
 27. Theapplicator of claim 1, wherein the single unit-dose is an amount ofabout 50 mg to about 500 mg of the composition.
 28. The applicator ofclaim 1, wherein the composition comprises about 0.1 mg to about 15 mgof the conjugated estrogen.
 29. The applicator of claim 1, wherein theconjugated estrogen is about 0.02% to about 5% of the total weight ofthe composition.
 30. The applicator of claim 1, wherein the diffusion ofestrone or equilin from the composition across human vaginal tissue isfrom about 50% to about 90% at 24 hours.
 31. The applicator of claim 1,wherein the composition further comprises carbomer.
 32. The applicatorof claim 31, wherein the hydrophilic excipient comprises water andglycerin.